Individual
COURTNEY CAROLANN CLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 SCENIC DR APT D, ALAMOGORDO, NM 88310-4441
(575) 415-2906
Mailing address
301 SCENIC DR APT D, ALAMOGORDO, NM 88310-4441
(575) 415-2906
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/10/2019
Last updated
03/10/2019
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