Andrew J Clark

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LEP3168 Issued in CA

Practice address

1219 Oak Knoll Rd
Santa Maria, CA 93455-4303

Phone

(805) 268-5218

NPI assigned

Dec 2, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1316215528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2531",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934572531",
            "telephone_number": "805-268-5218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 OAK KNOLL RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934554303",
            "telephone_number": "805-268-5218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "402 Farnel Rd",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "934584960",
            "country_code": "US",
            "telephone_number": "805-922-0334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANDREW",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-02",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CA",
            "license": "LEP3168",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CA",
            "license": "LEP3168",
            "primary": true
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "CA",
            "license": "LEP3168",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daisy C Cisneros-Becerra, PA-S1
• Adrian Cisneros
• Nathaniel Cisneros
• Raymond Cisneros
• Adam Clark
• Angela Janet Clark, CATC
• Christine Marie Clarke, IMFT
• Leah Ann Clarke, PA
• Minh Ngoc Clarke
• Steve Russell Clarke, M.D.

• All providers in Santa Maria, CA
• Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; 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.