Madeline Elizabeth Clark, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0701006781 Issued in VA

Practice address

720 Hickory St
Perrysburg, OH 43551-2447

Phone

(757) 289-2578

NPI assigned

May 3, 2020

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

Electronic endpoints 1

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": "1588464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588464000000",
    "number": "1407477201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 HICKORY ST",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435512447",
            "telephone_number": "757-289-2578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 HICKORY ST",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435512447",
            "telephone_number": "757-289-2578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MADELINE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-03",
        "last_updated": "2020-05-03",
        "certification_date": "2020-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0701006781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF COUNSELING",
            "identifier": "0701006781",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Perrysburg",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "720 Hickory St",
            "city": "Perrysburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "435512447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Churchills Perrysburg LTD
• Douglas I Cifuentes, D.O.
• Circle of Care Supportive Services
• CKC Medical Inc
• Christopher B Clark, DDS
• Stephen E. Clark, M.D.
• Jennifer Ann Clayton, PTA
• Christina M Clemens, MSSA, LISW
• Aireal Patrice Clinton, LPC
• Marissa Caitlin Coldren

• Mental Health Counselor in Perrysburg, OH
• Providers in Perrysburg, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2020; 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.