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NPI Code Detail

MEDICARE: ALEXIS VIOLET CLARK

MEDICARE: ALEXIS VIOLET CLARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1063113777
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS VIOLET CLARK
Provider Business Mailing Address
First Line : 17319 SAN PEDRO AVE STE 510
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78232-1444
Country : US
Telephone Number : 702-329-7287
Fax Number :
Provider Business Practice Location Address
First Line : 17319 SAN PEDRO AVE STE 510
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78232-1444
Country : US
Telephone Number : 702-329-7287
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2023
Last Update Date : 03/10/2023

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Directions to “ ALEXIS VIOLET CLARK ” Practice Location

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