MEDICARE: JULIA CLARK RBT

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
1	103K00000X	Behavior Analyst	RBT-24-395929	AR

General Provider Information

NPI Number	:	1417819087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA CLARK RBT

Provider Business Mailing Address
First Line	:	901 LACKEY RD
Second Line	:
City	:	MARION
State	:	AR
Zip	:	72364-5016
Country	:	US
Telephone Number	:	331-385-7180
Fax Number	:

Provider Business Practice Location Address
First Line	:	8090 WALNUT RUN RD
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-6362
Country	:	US
Telephone Number	:	901-509-8347
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ JULIA CLARK RBT” Practice Location

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