Joshua Wayne Clark

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

Practice address

4037 Ste a 214
Phelan, CA 92371

Phone

(760) 964-0153

NPI assigned

Aug 31, 2023

Last updated

Aug 31, 2023By the provider in NPPES

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

Practice roles

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.

• Helps Here

  • Child Intellectual and/or Developmental Disabilities Respite Care
  • Phelan, CA
  • NPI 1346073822
  NPD Authorized official

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

{
    "created_epoch": "1693440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1053197517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4037 STE A 214",
            "city": "PHELAN",
            "state": "CA",
            "postal_code": "92371",
            "telephone_number": "760-964-0153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4037 STE A 214",
            "city": "PHELAN",
            "state": "CA",
            "postal_code": "92371",
            "telephone_number": "760-964-0153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOSHUA",
        "middle_name": "WAYNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-31",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Cabrera
• Lindsay Calderon
• Nelene Castellanos, LVN
• Centro Medico Community Clinic, Inc
• Munju Anna Chung
• Kristianna Mercedes Clark, PPS
• Compassionate Care Behavioral Supports LLC
• Cierra Crampton, MS
• D J a M Inc (Phelan Family Pharmacy)
• Rachelle Davis, PHARMD

• Intellectual & Developmental Disabilities Psychologist in Phelan, CA
• Providers in Phelan, CA by specialty
• Intellectual & Developmental Disabilities Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; 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.