Provider Demographics
NPI:1609896240
Name:CLARK, HAROLD ULICE (ADDICTIONS THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:ULICE
Last Name:CLARK
Suffix:
Gender:M
Credentials:ADDICTIONS THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 JACKIES LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3287
Mailing Address - Country:US
Mailing Address - Phone:541-915-2280
Mailing Address - Fax:
Practice Address - Street 1:2400 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2042
Practice Address - Country:US
Practice Address - Phone:541-345-5395
Practice Address - Fax:541-345-7360
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)