Provider Demographics
NPI:1154685865
Name:CLARK, JAMES (BHRS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 624 A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7227
Mailing Address - Country:US
Mailing Address - Phone:405-242-5070
Mailing Address - Fax:405-242-5071
Practice Address - Street 1:2525 NW EXPRESSWAY
Practice Address - Street 2:SUITE 624 A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7227
Practice Address - Country:US
Practice Address - Phone:405-242-5070
Practice Address - Fax:405-242-5071
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst