Individual
COURTNEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
176A MAIN ST, CONWAY, NH 03818-6164
(603) 689-6188
Mailing address
PO BOX 22, CONWAY, NH 03818-0022
(603) 689-6188
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-23719
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3137577
—
NH
Enumeration date
03/10/2016
Last updated
08/14/2024
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