Clark, Walter Otha

Clark, Walter Otha is an individual health care provider with primary practice located at 3525 Presley Ave , Riverside CA 92507-4453. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Clark, Walter Otha can be contacted via phone (951) 782-2400.

Contact Information

Primary practice address
3525 Presley Ave Riverside CA 92507-4453
Phone: (951) 782-2400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 3051-I California
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 133051 II California

Profile Details

NPI number 1811230980
LBN Legal business name Clark, Walter Otha
Credentials CATC II
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 27th, 2013
Last updated Aug 22nd, 2013 - about 13 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 1811230980 NPPES
California Other 133051 II CAADE

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