Clark, Thomas Randall

Clark, Thomas Randall is an individual health care provider with primary practice located at 2116 4Th Ave Nw , Minot ND 58703-2967. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Clark, Thomas Randall can be contacted via phone (701) 838-2442.

Contact Information

Primary practice address
2116 4Th Ave Nw Minot ND 58703-2967
Phone: (701) 838-2442
Fax: (701) 839-1193
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X ND238 North Dakota

Profile Details

NPI number 1700833266
LBN Legal business name Clark, Thomas Randall
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700833266 NPPES
North Dakota MEDICAID 17462
North Dakota Other 11725

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