Individual
ANDREOUS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10475 CROSSPOINT BLVD STE 250, INDIANAPOLIS, IN 46256-3387
(462) 205-0087
Mailing address
10475 CROSSPOINT BLVD STE 250, INDIANAPOLIS, IN 46256-3387
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-207810
IN
Other
Enumeration date
12/19/2024
Last updated
12/19/2024
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