Jeffrey P. Clark, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

409 Issued in WY

Practice address

339 W Loucks St
Sheridan, WY 82801-4121

Phone

(307) 674-4462

Fax

(307) 674-4552

NPI assigned

Nov 2, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in WY

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

Specialty

Clinical Psychologist

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Big Horn Psychological Services LCGroup PAC ID 3375788839, 6 clinicians

Practice addresses (Care Compare)

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.

• Big Horn Psychological Services LC

  • Clinical Psychologist
  • Sheridan, WY
  • NPI 1336473859
  Medicare reassignment Care Compare group NPD
• Lisa McDuffie Psychiatry LLC

  • Psychiatry Physician
  • Sheridan, WY
  • NPI 1235887902
  NPD (past)
• Rehabilitation Enterprises of Northeastern Wyoming

  • Clinical Psychologist
  • Sheridan, WY
  • NPI 1689716227
  NPD (past)
• Renew

  • Case Management Agency
  • Sheridan, WY
  • NPI 1922331404
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063403822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1969 S SHERIDAN AVE",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828016108",
            "telephone_number": "307-672-7481",
            "fax_number": "307-674-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 W LOUCKS ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828014121",
            "telephone_number": "307-674-4462",
            "fax_number": "307-674-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JEFFREY",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WY",
            "license": "409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Sheridan (Sheridan Fire-Rescue)
• Claim Fixr LLC
• Alicia Clark
• Becky Sue Clark, LCSW
• Carol Clark, BA PSYCHOLOGY
• Mindy Clason
• Clay Smith MD PC
• Clear Eir Wellness, LLC
• Clear Image Laser Studio
• Amy Marie Clearwater

• Clinical Psychologist in Sheridan, WY
• Providers in Sheridan, WY by specialty
• Clinical Psychologist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.