Provider Demographics
NPI:1912651217
Name:CLARK, MONIKA KATARZYNA (MA, MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:KATARZYNA
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8308 BRITTANY HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7489
Mailing Address - Country:US
Mailing Address - Phone:170-223-5830
Mailing Address - Fax:
Practice Address - Street 1:8308 BRITTANY HARBOR DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7489
Practice Address - Country:US
Practice Address - Phone:702-235-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBA0867103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst