Tracy Clark Jr.

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-24-72860 Issued in CA

Practice address

6310 San Vicente Blvd Ste 300
Los Angeles, CA 90048-5447

Phone

(323) 693-1600

NPI assigned

Mar 27, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• ABA Behavioralservices LLC

  • Behavior Analyst
  • Los Angeles, CA
  • NPI 1417304288
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1104387687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6310 SAN VICENTE BLVD STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6310 SAN VICENTE BLVD STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485447",
            "telephone_number": "323-693-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TRACY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-27",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-24-72860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Wayne Clark, M.D.
• Sayda Vanessa Clark, MSW
• Stephen Clark
• Stevan Ray Clark, M.D.
• Tiffany Tenise Clark
• William Deangelo Clark
• Britney Shamay Clarke
• Cristina Edith Clarke, M.S
• Johan Alexander Clarke, MD
• Kalaki Marks Clarke, M.D.

• Behavior Analyst in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.