Ellen Clark, M.S.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2021005152 Issued in MO

Practice address

1430 Olive St Ste 400
Saint Louis, MO 63103-2303

Phone

(314) 206-3700

NPI assigned

Jan 10, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1346713526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 OLIVE ST STE 400",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631032303",
            "telephone_number": "314-206-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 OLIVE ST STE 400",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631032303",
            "telephone_number": "314-206-3700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "Wentzville",
            "state": "MO",
            "postal_code": "633853421",
            "country_code": "US",
            "telephone_number": "314-344-6700",
            "fax_number": "314-344-6194",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1014 Locust St Apt 504",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631011357",
            "country_code": "US",
            "telephone_number": "314-585-6445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELLEN",
        "credential": "M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-10",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2021005152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC",
            "identifier": "2021005152",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenna Clark
• Carolyn Marie Clark, NP
• Christine Mary Clark, M.A . ED.
• David B Clark, MD
• Dawn Martina Clark
• Haley Michelle Clark, FNP
• Jennifer Clark, SPEECH LANGUAGE PATH
• Jerome Clark, CPS, MRSS
• Jessica Clark
• Joan Marie Clark, ANP

• Mental Health Counselor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.