Eric Vinceson Clark Sr, is a
Clinic/center - Mental Health (including Community Mental Health Center) based in Shreveport, Louisiana. Eric Vinceson Clark Sr is licensed to practice in * (Not Available) (license number ) and his current practice location is
404 Hearne Ave, Shreveport, Louisiana. He can be reached at his office (for appointments etc.) via phone at
(318) 716-1369.
NPI number for Eric Vinceson Clark Sr is 1588194583 and his current mailing address is 404 Hearne Ave, Shreveport, Louisiana. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1588194583.
Healthcare Provider's Profile
| Full Name | Eric Vinceson Clark Sr |
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| Gender | Male |
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| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
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| Location | 404 Hearne Ave, Shreveport, Louisiana |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1588194583
- Provider Enumeration Date: 06/13/2017
- Last Update Date: 06/26/2023
Medical Identifiers
Medical identifiers for Eric Vinceson Clark Sr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1588194583 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Eric Vinceson Clark Sr is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Eric Vinceson Clark Sr,
404 Hearne Ave,
Shreveport, LA 71103-2022
Ph: (318) 716-1369 | Eric Vinceson Clark Sr,
404 Hearne Ave,
Shreveport, LA 71103-2022
Ph: (318) 716-1369 |
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