Organization
JERRY W CLARK, PHD, LTD.
Active
Other names
Behavioral Services Ltd
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY W CLARK PH.D. (OWNER)
(775) 772-0392
Entity
Organization
Contact information
Practice address
200 SO. VIRGINIA ST., 8TH FLOOR, RENO, NV 89501-2405
(775) 772-0392
(775) 772-0392
Mailing address
P. O. BOX 14223, RENO, NV 89507-4223
(775) 772-0392
(775) 972-6377
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
00004-C
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245454628
—
NV
Enumeration date
07/06/2011
Last updated
07/13/2011
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