Healthcare Provider Details

I. General information

NPI: 1891587374
Provider Name (Legal Business Name): CHRISTOPHER A CLARK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: C ALEX CLARK LMSW

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 BISHOPS LODGE RD
SANTA FE NM
87501-1099
US

IV. Provider business mailing address

1218 BISHOPS LODGE RD
SANTA FE NM
87501-1099
US

V. Phone/Fax

Practice location:
  • Phone: 316-992-6940
  • Fax:
Mailing address:
  • Phone: 316-992-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0434
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: