Provider Demographics
NPI:1346044765
Name:CLARK, PRESTON
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:CLARK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 DENVER WEST DR APT 1033
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3183
Mailing Address - Country:US
Mailing Address - Phone:253-228-8751
Mailing Address - Fax:
Practice Address - Street 1:1969 DENVER WEST DR APT 1033
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3183
Practice Address - Country:US
Practice Address - Phone:253-228-8751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician