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General NPI Number Information
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NPI Number | 1508758822
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Entity Type | Individual
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Provider Name | KARIS CLARK
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Gender | Female
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 200 S CLEVELAND
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City | MERIDIAN
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State | TX
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Zip | 76665-4802
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Country | US
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Telephone | 254-595-1364
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Fax |
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Provider Business Mailing Address
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Address Line | 623 COUNTY ROAD 2635
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City | WALNUT SPRINGS
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State | TX
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Zip | 76690-4731
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Country | US
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Telephone | 254-595-1364
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-299974
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License Number State | TX
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