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General NPI Number Information
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NPI Number | 1942367313
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Entity Type | Individual
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Provider Name | SHAKESHA S ANDERSON CLARKE
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 271 FT RICHARDSON AVE LIFE SKILLS SUPPORT CENTER- 17MDG
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City | GOODFELLOW AFB
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State | TX
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Zip | 76908-4901
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Country | US
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Telephone | 325-654-3122
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Fax | 325-654-5161
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Provider Business Mailing Address
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Address Line | 5216 FAIRWAY DR
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City | SAN ANGELO
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State | TX
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Zip | 76904-8759
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Country | US
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Telephone | 325-654-3122
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Fax | 325-654-5161
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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