Fawn M. Clark

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3 Kensington Square
Suite B
New Kensington, PA 15068

Phone

(724) 335-9733

Fax

(724) 335-9734

NPI assigned

Mar 11, 2010

Sex

Female

Sole proprietor

No

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.

• Alliance Counseling LLC

  • Mental Health Counselor
  • Vandergrift, PA
  • NPI 1780192161

  Mental Health

  NPD (past) Authorized official
• Family Behavioral Resources

  • Community/Behavioral Health Agency
  • New Kensington, PA
  • NPI 1003137753
  NPD (past)
• Family Behavioral Resources

  • Community/Behavioral Health Agency
  • New Kensington, PA
  • NPI 1851602023
  NPD (past)
• Family Behavioral Resources

  • Community/Behavioral Health Agency
  • New Kensington, PA
  • NPI 1881983260
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 11, 2010.

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268265600000",
    "number": "1205159779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 KENSINGTON SQUARE",
            "address_2": "SUITE B",
            "city": "NEW KENSINGTON",
            "state": "PA",
            "postal_code": "15068",
            "telephone_number": "724-335-9733",
            "fax_number": "724-335-9734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 KENSINGTON SQUARE",
            "address_2": "SUITE B",
            "city": "NEW KENSINGTON",
            "state": "PA",
            "postal_code": "15068",
            "telephone_number": "724-335-9733",
            "fax_number": "724-335-9734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "FAWN",
        "middle_name": "M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-11",
        "last_updated": "2010-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007624160014",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE BEHAVIORAL HEALTH",
            "identifier": "330989",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "184265",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA",
            "identifier": "424947",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7109257",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPMC",
            "identifier": "206234",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY BEHAVIORAL HEALTH ORGANIZATION",
            "identifier": "1000364",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2595457",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• CCP
• Cedars Surgical Associates Inc
• John Wesley Chancellor, M.D.
• Aubree Marie Churilla, LCSW
• Citizens Family Health Clinic Inc
• Community Care and Luv Home Care Agency, LLC
• Community Health Clinic, Inc.
• Community Health Clinic, Inc.
• Amanda Michelle Connolly, MS
• Michael William Contes, D.M.D.

• All providers in New Kensington, PA
• Mental Health Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; 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.