Jason Clark

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

2451 N Lincoln Ave Side 2
Chicago, IL 60614-4170

Phone

(773) 469-6675

NPI assigned

Jul 21, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: lifestancehealth.jasonclark@146897.advancedmd-direct.com

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

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595289600000",
    "number": "1033727425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1166 SILVERWOOD CT APT D1",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600902431",
            "telephone_number": "847-951-1961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 N LINCOLN AVE SIDE 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606144170",
            "telephone_number": "773-469-6675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JASON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-21",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Elizabeth Clark, MSW, PMH-C
• Erin Clark
• Hannah D Clark, PHD
• Ingrid Clark, MS, RD, LDN
• Janet O'Hare Clark, P.T.
• Jeffrey Clark, MD
• Jennifer L Clark
• Jill M Clark, D.C.
• Joseph Clark, MS, RD, CSSD
• Kametta Clark

• Mental Health Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.