Provider Demographics
NPI:1235600602
Name:BELLCLARK, KIM VERONICA
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:VERONICA
Last Name:BELLCLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-3717
Mailing Address - Country:US
Mailing Address - Phone:916-534-5144
Mailing Address - Fax:
Practice Address - Street 1:4220 46TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-3717
Practice Address - Country:US
Practice Address - Phone:916-534-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician