Provider Demographics
NPI:1386057727
Name:CLARK, ALLISON (PHD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3601 N MACGREGOR WAY
Mailing Address - Street 2:#240
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-8004
Mailing Address - Country:US
Mailing Address - Phone:713-873-3875
Mailing Address - Fax:713-873-3874
Practice Address - Street 1:3601 N MACGREGOR WAY
Practice Address - Street 2:#240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-8004
Practice Address - Country:US
Practice Address - Phone:713-873-3875
Practice Address - Fax:713-873-3874
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX36684103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist