Individual
DR. THOMAS RANDALL CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2116 4TH AVE NW, MINOT, ND 58703-2967
(701) 838-2442
(701) 839-1193
Mailing address
2116 4TH AVE NW, MINOT, ND 58703-2967
(701) 838-2442
(701) 839-1193
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
ND238
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11725
BLUE CROSS BLUE SHIELD
ND
05
—
17462
—
ND
Enumeration date
05/30/2006
Last updated
07/08/2007
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