MEDICARE: CLARKE DAVIS

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	106S00000X	Behavior Technician	22233781	TX

General Provider Information

NPI Number	:	1588447437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARKE DAVIS

Provider Business Mailing Address
First Line	:	8808 SADDLEHORN DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-4565
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 HOUSTON ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-7429
Country	:	US
Telephone Number	:	817-861-5000
Fax Number	:

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

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	08/15/2023

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Directions to “ CLARKE DAVIS ” Practice Location

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