JERRY CLARK (NPI# 1710465919) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710465919 |
| Entity Type | Individual |
| Full Name | JERRY CLARK |
| Practice Address |
27777 Inkster Rd Ste 100 Farmington Hills MI 48334-5326 |
| Practice Telephone | 2482990030 |
| Mailing Telephone | 2482990030 |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2020-02-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103K00000X | Behavioral Analyst | Behavioral Health & Social Service Providers | ||
| N | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548664766 | Jerry Kent Clark Jr. | Audiologist | 4611 Otter Ct, Burlington, NC 27215-9076 | 2014-10-17 |
| 1447490792 | Jerry W Clark | Counselor | 470 Bannon St, Sacramento, CA 95811-0204 | 2009-02-26 |
| 1114082872 | Jerry S Clark | Chiropractor | 3325 N University Ave Ste 125, Provo, UT 84604-6615 | 2006-12-23 |
| 1710058284 | Jerry D Clark | Counselor | 1830 Nasa Pkwy Ste 104, Houston, TX 77058-3544 | 2006-11-13 |
| 1639187297 | Jerry Christopher Clark | Massage Therapist | 2360 S Union Ave, Alliance, OH 44601-5079 | 2006-08-03 |
| 1497232060 | Jerry Dean Clark | Counselor | 1616 S Gold St Ste 4, Centralia, WA 98531-8930 | 2018-07-25 |
| 1881911261 | Jerry Lee Clark | Social Worker | 201 W Broadway St, Suite A, North Little Rock, AR 72114-5552 | 2010-04-26 |
| 1619203551 | Jerry R Clark | Dentist | 1115 W Friendly Ave, Greensboro, NC 27401-1844 | 2009-10-28 |
| 1356521371 | Jerry Lee Clark | Counselor | 112 N Broad St, Rm 821, Phila, PA 19102-1510 | 2007-11-07 |
| 1346280005 | Jerry A Clark | Internal Medicine | 722 N Fairfield Rd, Beavercreek, OH 45434-5918 | 2006-06-08 |
| Street Address |
27777 INKSTER RD STE 100 |
| City | FARMINGTON HILLS |
| State | MI |
| Zip Code | 48334-5326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558568758 | Beverly Lax-floyd | Technician, Other | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334 | 2007-06-29 |
| 1881295699 | Charles Malik Key | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-11-06 |
| 1790386621 | Jada Moraca | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-11-06 |
| 1023619889 | Christopher Leroi | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-11-06 |
| 1053912972 | Amanda Mccartney | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-11-06 |
| 1437750205 | Daris D Kinney | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-11-06 |
| 1073114914 | Andrea Guillen Villegas | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-11-06 |
| 1376144352 | Kathryn Marie Lee | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-11-05 |
| 1467053439 | Dawn Davidson | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-11-05 |
| 1952902967 | Mylia Patwin | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5312 | 2020-11-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588264535 | Kiah Bradley | Behavior Technician | 2777 Inkster Rd Suite 100, Farmington Hills, MI 48334 | 2020-10-29 |
| 1417557307 | Carsen D Dresbach | Behavior Technician | 2777 Inster Road Suite 100, Farmington Hills, MI 48334 | 2020-10-29 |
| 1316560303 | Amy K Pruneau LLC | Psychologist | 26755 Middlebelt Rd Ste 140, Farmington Hills, MI 48334 | 2020-05-25 |
| 1366089732 | Vian Aljony | Dental Hygienist | 27273 Arden Park Cir, Farmington Hills, MI 48334 | 2019-12-04 |
| 1699311902 | Sandra Zori | Pharmacist | 27800 Middlebelt Rd, Farmington Hills, MI 48334 | 2019-11-21 |
| 1902450471 | Kianna Marie Garcia | Behavior Technician | 27777 Inkster Rd., Farmington Hills, MI 48334 | 2019-08-01 |
| 1619521176 | Samantha Serra | Behavior Technician | 27777 Inkster Rd Suite 100, Farmington Hills, MI 48334 | 2019-08-01 |
| 1851945398 | Kristen Butler | Behavior Technician | 27777 Inkster Road Suite 100, Farmington Hills, MI 48334 | 2019-08-01 |
| 1104489038 | Katherine Kalsow | Behavioral Analyst | 27777 Inkster Rd. Suite 100, Farmington Hills, MI 48334 | 2019-04-16 |
| 1083178487 | Imee Raterta | Physical Therapist | Ability Works Rehab, 28592 Orchard Lake Rd # 300, Farmington Hills, MI 48334 | 2019-01-30 |
| Find all providers in zip 48334 | ||||
| Taxonomy Code | 103K00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavioral Analyst |
| A behavior analyst is qualified by at least a master’s degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans. |
| Notes: Source: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2008: new, 1/1/2016: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982232351 | Jessica Lavander Biggs | Behavioral Analyst | 28116 Orchard Lake Rd Ste 100, Farmington Hills, MI 48334-3713 | 2020-03-31 |
| 1023649548 | Brandon Scott Gillespie | Behavioral Analyst | 30301 Northwestern Hwy Ste 300, Farmington Hills, MI 48334-3279 | 2020-02-03 |
| 1104489038 | Katherine Kalsow | Behavioral Analyst | 27777 Inkster Rd. Suite 100, Farmington Hills, MI 48334 | 2019-04-16 |
| 1447787098 | Shanna Havenstein | Behavioral Analyst | 2777 Inkster Rd., Ste. 100, Farmington Hills, MI 48334-4819 | 2017-05-15 |
| 1073993408 | Lauren Michelle Declaire | Behavioral Analyst | 27777 Inkster Rd # 100, Farmington Hills, MI 48334-5326 | 2015-06-01 |
| 1285020511 | Carol Franey | Behavioral Analyst | 32811 Middlebelt Rd, Farmington Hills, MI 48334 | 2015-04-14 |
| 1013348648 | Sireece Bass | Behavioral Analyst | 21379 Tulane Ave Apt 201, Farmington Hills, MI 48336-5670 | 2013-12-08 |
| 1336761147 | Michigan School of Psychology | Behavioral Analyst | 26811 Orchard Lake Rd, Farmington Hills, MI 48334-4512 | 2020-05-14 |
| 1922620780 | Julia Anne Szalwinski | Behavioral Analyst | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5326 | 2020-05-14 |
| 1235780149 | Emily Claire Abramson | Behavioral Analyst | 24555 Hallwood Ct, Farmington Hills, MI 48335-1667 | 2019-09-23 |
| Find all providers in FARMINGTON HILLS | ||||
| City | FARMINGTON HILLS |
| Zip Code | 48334 |
Please comment or provide details below to improve the information on JERRY CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.