Individual
SHERRY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7030 CAPELLA PARK AVE, DALLAS, TX 75236-3003
(817) 540-1363
Mailing address
7030 CAPELLA PARK AV, DALLAS, TX 75236
(817) 540-1363
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
320900000
TX
Other
Enumeration date
06/05/2015
Last updated
06/05/2015
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