Theresa Clark

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

47533 Issued in CA

Practice address

1800 Gravenstein Hwy N
Sebastopol, CA 95472-2607

Phone

(707) 634-9034

Fax

(707) 823-3410

NPI assigned

Nov 13, 2009

Last updated

Jul 8, 2016By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Telecare Corporation

  dba Valley Vista Permanent Supportive Housing

  • Mental Illness Community Based Residential Treatment Facility
  • San Diego, CA
  • NPI 1275398935
  NPD
• Telecare Corporation

  dba Gateway To Recovery

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Diego, CA
  • NPI 1720164882
  NPD
• Telecare Corporation

  dba Telecare Sonoma ACT

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Santa Rosa, CA
  • NPI 1902931595
  NPD

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

{
    "created_epoch": "1258070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467936000000",
    "number": "1457688384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 GRAVENSTEIN HWY N",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954722607",
            "telephone_number": "707-634-9063",
            "fax_number": "707-823-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 GRAVENSTEIN HWY N",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954722607",
            "telephone_number": "707-634-9034",
            "fax_number": "707-823-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "THERESA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-13",
        "last_updated": "2016-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "47533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Geetinder Kaur Chattha, M.D.
• Katharine Chalmers Chelton
• CHI Recovery, Inc.
• Arianna Chretien-Fornaciai
• Breanna Rachell Christenson, NMT , CMT
• Kathleen Coffey, OT
• Carol Adele Coleman, MFT
• Justin Collmann, PH.D.
• Compassionate Concierge Care
• Compassionate Integrative Counseling PC (Compassionate Integrative Counseling Group)

• Marriage & Family Therapist in Sebastopol, CA
• Providers in Sebastopol, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.