Provider Demographics
NPI:1740456300
Name:HEATHER JORDON CLARK PHD LLC
Entity type:Organization
Organization Name:HEATHER JORDON CLARK PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:JORDON
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-960-8900
Mailing Address - Street 1:600 SW 3RD ST
Mailing Address - Street 2:SUITE 2270
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6932
Mailing Address - Country:US
Mailing Address - Phone:954-960-8900
Mailing Address - Fax:954-960-8888
Practice Address - Street 1:600 SW 3RD ST
Practice Address - Street 2:SUITE 2270
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6932
Practice Address - Country:US
Practice Address - Phone:954-960-8900
Practice Address - Fax:954-960-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7620103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty