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General NPI Number Information
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NPI Number | 1063988939
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Entity Type | Individual
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Provider Name | BRANDON K CLARK LCDC-I
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Gender | Male
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2400 S LOOP W
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City | HOUSTON
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State | TX
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Zip | 77054-2800
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Country | US
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Telephone | 832-429-7219
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Fax |
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Provider Business Mailing Address
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Address Line | 2380 MARTIN LUTHER KING JR AVE APT 7
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City | GRAMBLING
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State | LA
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Zip | 71245-2113
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Country | US
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Telephone | 318-607-4302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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