Jerry W Clark, PHD, LTD.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

00004-C Issued in NV

Legal business name

JERRY W CLARK, PHD, LTD.

Practice address

200 So. Virginia St.
8TH Floor
Reno, NV 89501-2405

Phone

(775) 772-0392

Fax

(775) 772-0392

NPI assigned

Jul 6, 2011

Last updated

Jul 13, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jerry W Clark, PH.D.

Title

Owner

Phone

(775) 772-0392

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Behavioral Services Ltd Former legal business name

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

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310515200000",
    "number": "1750678108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 14223",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895074223",
            "telephone_number": "775-772-0392",
            "fax_number": "775-972-6377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SO. VIRGINIA ST.",
            "address_2": "8TH FLOOR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895012405",
            "telephone_number": "775-772-0392",
            "fax_number": "775-772-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY W CLARK, PHD, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-06",
        "last_updated": "2011-07-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-772-0392",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "00004-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245454628",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Behavioral Services Ltd",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Tony Clark Jensen, CHIROPRACTOR
• Su Hyun Jeong, MD
• Amanda Jeppesen, PHARMD
• Onna Jernigan, MD
• Jerry Matsumura MD, Inc. a Professional Corporation
• Sandra Lee Jersey
• Andrew Sameer Jessani
• Rebecca Jessee
• Heather Jessop
• Corey Jessup, M.A., B.A.

• Clinical Social Worker in Reno, NV
• Providers in Reno, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2011; 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.