Provider Demographics
NPI:1316284425
Name:CLARK, JANET (PSY, LEP, BCBA)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:PSY, LEP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 BIG CANYON CT
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-5101
Mailing Address - Country:US
Mailing Address - Phone:661-201-0902
Mailing Address - Fax:
Practice Address - Street 1:195 BIG CANYON CT
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-5101
Practice Address - Country:US
Practice Address - Phone:661-201-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY35199103TC0700X
CA1-08-4302103K00000X
CALEP 2868103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool