Richard Clark II, MA
Individual provider Active NPI Counselor · Monticello, FL
NPI 1306737515 · NPPES record last updated Jul 14, 2025
Key facts
- NPI
- 1306737515
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- IMH27487 (FL)
- Practice address
- 984 Boston Hwy
Monticello, FL 32344-4758 - Phone
- (407) 448-2546
- NPI assigned
- Jul 14, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMH27487 | FL | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | IMH27487 | FL | Yes |
Addresses
Primary practice location
984 Boston Hwy
Monticello, FL 32344-4758
Mailing address
2313 Astoria CT
Tallahassee, FL 32303-3309
Phone (407) 448-2546
Other providers in Monticello, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.