Healthcare Provider Details

I. General information

NPI: 1811293228
Provider Name (Legal Business Name): ROBERT CLARK II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 OAKLEY SEAVER DR STE 206
CLERMONT FL
34711-1950
US

IV. Provider business mailing address

1230 OAKLEY SEAVER DR STE 206
CLERMONT FL
34711-1950
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-8815
  • Fax: 877-749-1902
Mailing address:
  • Phone: 352-234-8815
  • Fax: 877-749-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18810
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: