Most Relevant Information
Provider Data
| NPI Number: | 1003638792 |
| Provider Name: | BENJAMIN CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/25/2024 |
| Last Updated: | 10/25/2024 |
Provider Practice Location
320 DECKER DR
IRVING
TX
750623999
Practice Location Phone/Fax
| Phone: | 9725857030 |
| Fax: |
Provider Mailing Location
7108 S KANNER HWY
STUART
FL
349977462
Provider Mailing Phone/Fax
| Phone: | 8558326727 |
| Fax: |