Theresa L Clark, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

DR.0061413 Issued in CO

Practice address

114 Village Place
St 207
Dillon, CO 80435

Phone

(970) 455-9004

Fax

(949) 577-4247

NPI assigned

Oct 16, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, CO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Psychiatry

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tclark170505@direct.dhha.org

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.

• Ten Mile Health & Wellness LLC

  • Psychiatry Physician
  • Dillon, CO
  • NPI 1417538281

  CO, Psychiatry

  Medicare reassignment NPD Authorized official
• Denver Health and Hospital Authority

  • General Practice Physician
  • Denver, CO
  • NPI 1477569838

  CO

  Medicare reassignment NPD
• Behavioral Health Management Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Clearwater, FL
  • NPI 1417052713

  FL

  Medicare reassignment NPD
• Denver Health and Hospital Authority

  • Psychiatric Hospital Unit
  • Denver, CO
  • NPI 1689624942
  NPD
• Behavioral Health Management Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Valrico, FL
  • NPI 1215403662
  NPD

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747440000000",
    "number": "1104015155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2098",
            "city": "DILLON",
            "state": "CO",
            "postal_code": "804352098",
            "telephone_number": "970-455-9004",
            "fax_number": "949-577-4247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 VILLAGE PLACE",
            "address_2": "ST 207",
            "city": "DILLON",
            "state": "CO",
            "postal_code": "80435",
            "telephone_number": "970-455-9004",
            "fax_number": "949-577-4247"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "777 Bannock St",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802044507",
            "country_code": "US",
            "telephone_number": "303-436-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "THERESA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-16",
        "last_updated": "2025-05-17",
        "certification_date": "2025-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35.135479",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME104695",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "TRN11797",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "DR.0061413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Brown, MS, LAC, NCAC II
• Jessica Vera Burrows, PA-C
• Vicki Carey, MA, LPC
• Truley C Check, FNP
• Isaura Concepcion Cirillo, DDS
• Christian Wells Coggeshall
• Colorado Mountain Medical, LLC
• Colorado Mountain Medical, LLC
• Colorado Mountain Medical, LLC
• Colorado Mountain Medical, LLC

• All providers in Dillon, CO
• Psychiatry Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2025; 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.