Miles Anthony Clark, MFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LMFT48989 Issued in CA

Practice address

34175 Philo Greenwood Rd
Elk, CA 95432

Phone

(707) 877-3406

NPI assigned

Jan 7, 2019

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

State licenses

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

{
    "created_epoch": "1546819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1104399765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 77",
            "city": "ELK",
            "state": "CA",
            "postal_code": "954320077",
            "telephone_number": "707-877-3406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34175 PHILO GREENWOOD RD",
            "city": "ELK",
            "state": "CA",
            "postal_code": "95432",
            "telephone_number": "707-877-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MILES",
        "middle_name": "ANTHONY",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-07",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LMFT48989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elk Community Services District
• Elk Volunteer Fire Department
• Kathleen Siobhan Hayes, MA
• Luanne J Lobbezoo, MD
• Claudia Lucia Martinez Vandenbergh, LCSW

• Mental Health Counselor in Elk, CA
• Providers in Elk, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; 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.