Healthcare Provider Details

I. General information

NPI: 1417819087
Provider Name (Legal Business Name): JULIA CLARK RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8090 WALNUT RUN RD
CORDOVA TN
38018-6362
US

IV. Provider business mailing address

901 LACKEY RD
MARION AR
72364-5016
US

V. Phone/Fax

Practice location:
  • Phone: 901-509-8347
  • Fax:
Mailing address:
  • Phone: 331-385-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-24-395929
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: