ERIC VINCESON CLARK NPI 1588194583

NPI Information

NPI: 1588194583
Provider Name: ERIC VINCESON CLARK
Classification: Clinic/Center - 261QM0801X
Entity Type: Individual

Specialization: Mental Health (Including Community Mental Health Center)

Address:
404 HEARNE AVE
SHREVEPORT, LA
ZIP 71103
Phone: (318) 716-1369
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Eric Vinceson Clark is a mental health (including community mental health center) clinic center in Shreveport, LA. Eric Vinceson Clark NPI is 1588194583. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

404 HEARNE AVE
SHREVEPORT, LA
ZIP 71103-022
Phone: (318) 716-1369
Fax: (318) 675-0120

The enumeration date for this NPI number is 6/13/2017 and was last updated on 6/26/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health			No
2	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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