Provider Demographics
NPI:1720374416
Name:CLARK, PHILIP HONE
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:HONE
Last Name:CLARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:NV
Mailing Address - Zip Code:89311-0166
Mailing Address - Country:US
Mailing Address - Phone:775-234-7267
Mailing Address - Fax:
Practice Address - Street 1:2000 HIDDEN CANYON PARKWAY
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:NV
Practice Address - Zip Code:89311
Practice Address - Country:US
Practice Address - Phone:775-234-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor