| Jerry W Clark, Phd, Ltd. | |
|
200 So. Virginia St. 8th Floor Reno NV 89501-2405 | |
| (775) 772-0392 | |
| (775) 772-0392 |
| Full Name | Jerry W Clark, Phd, Ltd. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 200 So. Virginia St., Reno, Nevada |
| Authorized Official Name and Position | Jerry W Clark (OWNER) |
| Authorized Official Contact | 7757720392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jerry W Clark, Phd, Ltd. P. O. Box 14223 Reno NV 89507-4223 Ph: (775) 772-0392 | Jerry W Clark, Phd, Ltd. 200 So. Virginia St. 8th Floor Reno NV 89501-2405 Ph: (775) 772-0392 |
| NPI Number | 1750678108 |
|---|---|
| Provider Enumeration Date | 07/06/2011 |
| Last Update Date | 07/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750678108 | NPI | - | NPPES |
| 1245454628 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 00004-C (Nevada) | Primary |
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