Provider Demographics
NPI:1689564924
Name:CLARK NP IN PSYCHIATRY SERVICES P.C.
Entity type:Organization
Organization Name:CLARK NP IN PSYCHIATRY SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHALITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:347-460-9267
Mailing Address - Street 1:820 MICHELLE MNR
Mailing Address - Street 2:
Mailing Address - City:MONTEVALLO
Mailing Address - State:AL
Mailing Address - Zip Code:35115-1111
Mailing Address - Country:US
Mailing Address - Phone:205-936-0429
Mailing Address - Fax:
Practice Address - Street 1:30 WALL ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2205
Practice Address - Country:US
Practice Address - Phone:347-460-9267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty