Individual
PARIS CLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1133 COLOMA WAY STE C, ROSEVILLE, CA 95661-4480
(916) 774-6456
Mailing address
7246 REMMET AVE, CANOGA PARK, CA 91303-1531
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
42058
CA
Other
Enumeration date
02/15/2023
Last updated
02/15/2023
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