Individual
TARA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6330 NW KELLY DR STE A, PARKVILLE, MO 64152-4027
(816) 469-5162
(816) 491-8173
Mailing address
6330 NW KELLY DR STE A, PARKVILLE, MO 64152-4027
(816) 469-5162
(816) 491-8173
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MO
106S00000X
Behavior Technician
—
—
Other
Enumeration date
10/16/2019
Last updated
10/16/2019
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