Provider Demographics
NPI:1326634072
Name:CLARK, BRITNEY (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16782 VON KARMAN AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2417
Mailing Address - Country:US
Mailing Address - Phone:949-833-2237
Mailing Address - Fax:
Practice Address - Street 1:2561 PENDLETON RD
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117-3914
Practice Address - Country:US
Practice Address - Phone:843-607-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-23-65343103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst