Stephanie J Clark

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT121955 Issued in CA

Practice address

921 W Avenue J Ste C
Lancaster, CA 93534

Phone

(661) 949-0131

Fax

(661) 729-8912

NPI assigned

Nov 3, 2017

Last updated

Sep 29, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healing Solutions Family Therapy Center Inc.

  dba Healing Solutions Family Therapy Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lancaster, CA
  • NPI 1134688674
  Medicare reassignment NPD
• All for Kids Organization

  • Community/Behavioral Health Agency
  • Lancaster, CA
  • NPI 1548396161
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1033621768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 W AVENUE J STE C",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935343443",
            "telephone_number": "661-949-0131",
            "fax_number": "661-729-8912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 W AVENUE J STE C",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "93534",
            "telephone_number": "661-949-0131",
            "fax_number": "661-729-8912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8220 S San Pedro St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900033030",
            "country_code": "US",
            "telephone_number": "323-570-0445",
            "fax_number": "323-778-0485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHANIE",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-03",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "AMFT99619",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT121955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508206838",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Roshawn Clark
• Lacey Clark, LCSW
• Mavis J. Clark
• Ronesha Dominque Clark
• Samantha Marie Clark
• Terence Clark
• Patricia Ann Clarke, SLP
• Keith Clarkson
• Leslie Clarkson Jr.
• Alyssa Anne Claudio

• Marriage & Family Therapist in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.