Stacie Clark, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC 41753 Issued in CA

Practice address

19 E 6TH St
Tracy, CA 95376-4107

Phone

(209) 835-8583

Fax

(209) 956-4245

NPI assigned

Apr 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Valley Community Counseling Services, Inc

  • Community/Behavioral Health Agency
  • Tracy, CA
  • NPI 1629191978
  NPD (past)

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1235352279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 E 6TH ST",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953764107",
            "telephone_number": "209-835-8583",
            "fax_number": "209-956-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 E 6TH ST",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953764107",
            "telephone_number": "209-835-8583",
            "fax_number": "209-956-4245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STACIE",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT41753",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 41753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tania Gabriela Cisneros-Ventura, MFTI
• Erica Stacey Cisneros
• Hadasa Cisneros
• City of Tracy
• Lisa Michelle Clark-Barlow, FNP
• Tracy Coffman
• Rowena Cohen
• Taylor Renee Coleman
• Lindsay Krystina Collins, M.A., CCC-SLP
• Iniciah Colon

• Marriage & Family Therapist in Tracy, CA
• Providers in Tracy, 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 Nov 29, 2023; 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.