Provider Demographics
NPI:1508758822
Name:CLARK, KARIS
Entity type:Individual
Prefix:
First Name:KARIS
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 COUNTY ROAD 2635
Mailing Address - Street 2:
Mailing Address - City:WALNUT SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:76690-4731
Mailing Address - Country:US
Mailing Address - Phone:254-595-1364
Mailing Address - Fax:
Practice Address - Street 1:200 S CLEVELAND
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:TX
Practice Address - Zip Code:76665-4802
Practice Address - Country:US
Practice Address - Phone:254-595-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-299974106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician