Provider Demographics
NPI:1427135763
Name:CLARK, BARBARA DEL (PHD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:DEL
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 GLADE ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4341
Mailing Address - Country:US
Mailing Address - Phone:979-693-6759
Mailing Address - Fax:979-696-9296
Practice Address - Street 1:1711 GLADE ST
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4341
Practice Address - Country:US
Practice Address - Phone:979-693-6759
Practice Address - Fax:979-696-9296
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22632103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist