Provider Demographics
NPI:1639187735
Name:VINSON, CLARK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLARK
Middle Name:
Last Name:VINSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:CLARK
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:972 MEADOW OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-1928
Mailing Address - Country:US
Mailing Address - Phone:817-313-0742
Mailing Address - Fax:
Practice Address - Street 1:1007 W MITCHELL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2508
Practice Address - Country:US
Practice Address - Phone:817-461-6183
Practice Address - Fax:817-265-7433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR69233OtherSEVERAL MNGED CARE CO.'S
TXSWOOS87N4Medicare ID - Type Unspecified