Active NPI
Cherie Clark, M.A.
- Mental Health Counselor
- Indianapolis, IN
National Provider Identifier
1376766170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 39000122A
- Practice address
- 9111 Haverstick Rd
Indianapolis, IN 46240-1353 - Phone
- (317) 575-6500
- Fax
- (317) 575-6501
- NPI assigned
- Apr 10, 2007
- Sex
- Female
- 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 | 39000122A | IN | Primary |
Addresses
Primary practice location
9111 Haverstick Rd
Indianapolis, IN 46240-1353
Mailing address
9111 Haverstick Rd
Indianapolis, IN 46240-1353
Phone (317) 575-6500
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 |
|---|---|---|---|
| 39000122A | IN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376766170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9111 HAVERSTICK RD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462401353",
"telephone_number": "317-575-6500",
"fax_number": "317-575-6501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9111 HAVERSTICK RD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462401353",
"telephone_number": "317-575-6500",
"fax_number": "317-575-6501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHERIE",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39000122A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
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.