Provider Demographics
NPI:1962875583
Name:CLARK, RENEKA (MSW, LCSW-BACS)
Entity type:Individual
Prefix:MRS
First Name:RENEKA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSW, LCSW-BACS
Other - Prefix:
Other - First Name:RENEKA
Other - Middle Name:
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2518 KIPLANDS WAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1532
Mailing Address - Country:US
Mailing Address - Phone:318-379-6504
Mailing Address - Fax:318-625-0636
Practice Address - Street 1:5757 WOODWAY DR STE 327
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1514
Practice Address - Country:US
Practice Address - Phone:832-305-6706
Practice Address - Fax:318-625-0636
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11155104100000X
TX1060541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106054OtherTEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL
LA11155OtherLOUISIANA STATE BOARD OF SOCIAL WORK EXAMINERS
TX1457979056Medicaid