Individual
REBECCA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FOSTER PARENT
Contact information
Practice address
2703 S 37TH DR, YUMA, AZ 85364-5983
(928) 726-1636
Mailing address
2703 S 37TH DR, YUMA, AZ 85364-5983
(928) 726-1636
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
11351
—
Other
Enumeration date
12/25/2006
Last updated
07/08/2007
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