Active NPI
Robert D Wark, MA LMFT
- Marriage & Family Therapist
- Big Lake, MN
National Provider Identifier
1285964023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 2097
- Practice address
- 101 Jefferson Blvd
Big Lake, MN 55309-9572 - Phone
- (763) 367-6080
- Fax
- (763) 263-7897
- NPI assigned
- Dec 29, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 2097 | MN | Primary |
Addresses
Primary practice location
101 Jefferson Blvd
Big Lake, MN 55309-9572
Mailing address
101 Jefferson Blvd
PO Box 3
Big Lake, MN 55309-9572
Phone (763) 367-6080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2097 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262044800000",
"number": "1285964023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 JEFFERSON BLVD",
"address_2": "PO BOX 3",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553099572",
"telephone_number": "763-367-6080",
"fax_number": "763-263-7897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 JEFFERSON BLVD",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553099572",
"telephone_number": "763-367-6080",
"fax_number": "763-263-7897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARK",
"first_name": "ROBERT",
"middle_name": "D",
"credential": "MA LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-29",
"last_updated": "2009-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "2097",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Big Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.