Provider Demographics
NPI:1336520295
Name:CLARK, CAROL H (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:H
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:CLARK-YEOMANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:210 LOWRY ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5274
Mailing Address - Country:US
Mailing Address - Phone:830-377-7659
Mailing Address - Fax:
Practice Address - Street 1:210 LOWRY ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5274
Practice Address - Country:US
Practice Address - Phone:830-377-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22633103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist