Patricia Ann Clark, MFTI

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

IMF 75971 Issued in CA

Practice address

429 Speers Rd
Santa Rosa, CA 95409-3123

Phone

(707) 571-2215

NPI assigned

Feb 18, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ann Clark Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• R House, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Santa Rosa, CA
  • NPI 1760516702
  NPD (past)

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

{
    "created_epoch": "1392681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392681600000",
    "number": "1073937637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2587",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954050587",
            "telephone_number": "707-527-2215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 SPEERS RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954093123",
            "telephone_number": "707-571-2215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PATRICIA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MFTI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-18",
        "last_updated": "2014-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF 75971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANN",
            "last_name": "CLARK",
            "credential": "MFTI",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Clelia Alexandra Clark, MD
• Jennifer Lee Clark
• Jennifer M. Clark, R.N., FNP, PMHNP
• Johnson Jack Clark Jr., MD
• Karen Marie Clark, N.P.
• Patricia Pusey Clark, MFT MARRIAGE AND FAM
• Gayle Lynn Clay
• Randy Clay
• Ruby Joy Clay
• Brenda Clayton

• Marriage & Family Therapist in Santa Rosa, CA
• Providers in Santa Rosa, 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 Feb 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.