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Richard Jack Clark, PEERSUPPORT
Peer Specialist in Salt Lake City, Utah
NPI 1316393283

Richard Jack Clark is a Peer Specialist based in Salt Lake City, UT. Richard Jack Clark practices in Salt Lake City, UT and has the professional credentials of PEERSUPPORT. The NPI Number for Richard Jack Clark is 1316393283 and holds a License No. #518 (Utah).

The current practice location address for Richard Jack Clark is 68 S 600 E, Salt Lake City, UT and can be reached out via phone at 801-428-3244.

Location: 68 S 600 E, Salt Lake City, UT, 84102-1007
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1316393283
Provider Name
Richard Jack Clark
Credential
PEERSUPPORT
Provider Entity Type
Individual
Gender
Male
Address
68 S 600 E, Salt Lake City, UT, 84102-1007
Phone Number
801-428-3244
Fax Number
Provider Enumeration Date
05/10/2016
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
68 S 600 E
City
Salt Lake City
State
Utah
Zip
84102-1007
Phone Number
801-428-3244
Fax Number
person
Provider Business Mailing Address Details
Address
68 S 600 E
City
Salt Lake City
State
Utah
Zip
84102-1007
Phone Number
801-428-3244
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
#518 (Utah)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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