Individual
MIKAELA KURIN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY
Contact information
Practice address
2110 LOS FELIZ ST UNIT 2072, LAS VEGAS, NV 89156-8026
(702) 808-9204
Mailing address
5057 GABLE CREST CT, LAS VEGAS, NV 89141-3880
(808) 342-7392
(702) 992-0326
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
NV
103T00000X
Psychologist
—
NV
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
NV
Other
Enumeration date
02/22/2018
Last updated
02/22/2018
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