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NPI Code Detail

MEDICARE: PAMELA MISHAY CLARK BCBA

MEDICARE:   PAMELA MISHAY CLARK  BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1487162269
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA MISHAY CLARK BCBA
Provider Business Mailing Address
First Line : 6410 N FLORES ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78212-1125
Country : US
Telephone Number : 803-237-7028
Fax Number :
Provider Business Practice Location Address
First Line : 6410 N FLORES ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78212-1125
Country : US
Telephone Number : 803-237-7028
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2018
Last Update Date : 09/24/2019

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Directions to “ PAMELA MISHAY CLARK BCBA” Practice Location

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