Jill Jeffers Clark, MA, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY20715 Issued in CA

Practice address

874 57TH St
Sacramento, CA 95819-3327

Phone

(916) 739-1926

Fax

(916) 739-1591

NPI assigned

Mar 20, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Restoring Family Harmony

  • Clinical Psychologist
  • Sacramento, CA
  • NPI 1073828273
  NPD (past) Authorized official
• Marriage & Family Therapy for Peace of Mind Corporation

  • Marriage & Family Therapist
  • Sacramento, CA
  • NPI 1316647480
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447375563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 RIVERGATE WAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958313344",
            "telephone_number": "916-739-1926",
            "fax_number": "916-739-1591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "874 57TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193327",
            "telephone_number": "916-739-1926",
            "fax_number": "916-739-1591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JILL",
        "middle_name": "JEFFERS",
        "name_prefix": "Dr.",
        "credential": "MA, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY20715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faye M Clark, MFT
• Fred Allen Clark, PHD, LMFT
• Isaiah James Clark, MD
• James Russell Clark, CADCA
• Jessica Lynne Clark, LCSW
• Joeanna Clark
• Juli Ann Clark
• Julie Alysia Clark, RADT
• Kacee Lynn Clark
• Kaylyn Clark

• Psychologist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Psychologist in California

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.