Active NPI
Jerry C Clerc, MED LPC
- Mental Health Counselor
- Clayton, MO
National Provider Identifier
1366503740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 000683
- Practice address
- 225 So Meramec
St 506
Clayton, MO 63105 - Phone
- (314) 863-3588
- Fax
- (314) 863-0074
- NPI assigned
- Dec 12, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 000683 | MO | Primary |
Addresses
Primary practice location
225 So Meramec
St 506
Clayton, MO 63105
Mailing address
3631 Tamm
St Louis, MO 63109
Phone (314) 863-3588
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ANTHEM 1111 | Other | MO | BCBS ANTHEM NUMBER |
Other names 1
- Jerome C Clerc
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 Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000683 | MO | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Psychological Group, Inc | Past | Accepting new patients | |
| Paul H Wang M Div PH D & Associates P C | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychologist
- Saint Louis, MO
- NPI 1952684995
-
- Prescribing (Medical) Psychologist
- Saint Louis, MO
- NPI 1386767994
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366503740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3631 TAMM",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63109",
"telephone_number": "314-863-3588",
"fax_number": "314-863-0074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 SO MERAMEC",
"address_2": "ST 506",
"city": "CLAYTON",
"state": "MO",
"postal_code": "63105",
"telephone_number": "314-863-3588",
"fax_number": "314-863-0074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLERC",
"first_name": "JERRY",
"middle_name": "C",
"credential": "MED LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "000683",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS ANTHEM NUMBER",
"identifier": "ANTHEM 1111",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JEROME",
"last_name": "CLERC",
"middle_name": "C",
"credential": "MED LPC",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Clayton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.