Dorthea A Clark, MA IN MENTAL HEALTH

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PPC-1416 Issued in WY

Practice address

4025 Rawlins St
Cheyenne, WY 82001-1900

Phone

(307) 426-4797

NPI assigned

Nov 15, 2023

Last updated

Nov 15, 2023By the provider in NPPES

Sex

Female

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

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1154196665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 RAWLINS ST",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820011900",
            "telephone_number": "307-631-7381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 RAWLINS ST",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820011900",
            "telephone_number": "307-426-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DORTHEA",
        "middle_name": "A",
        "credential": "MA IN MENTAL HEALTH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-15",
        "last_updated": "2023-11-15",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WY",
            "license": "PPC-1416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City Drug
• City Drug Pharmacy
• City of Cheyenne (Cheyenne Fire Rescue)
• CJ Services of Wyoming, Inc.
• Christopher Ryan Clair, PPC
• Edward Mark Clark, DDS
• Emily L Clark, BA
• Jackeline Clark
• Jeffrey Clark
• Kendra E. Clark, CPS

• Mental Health Counselor in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Mental Health Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.