Active NPI
Bradley Clark, MA LPCC LADC
- Mental Health Counselor
- Lindstrom, MN
National Provider Identifier
1467112342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 3068
- Practice address
- 12814 Lake Blvd
Lindstrom, MN 55045-9345 - Phone
- (651) 755-4276
- Fax
- (888) 972-5307
- NPI assigned
- Dec 20, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | 3068 | MN | Primary |
Addresses
Primary practice location
12814 Lake Blvd
Lindstrom, MN 55045-9345
Mailing address
PO Box 974
Lindstrom, MN 55045-0974
Phone (651) 755-4276
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | bclark@counselingkidsandadults.com | Direct |
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 |
|---|---|---|---|
| 3068 | MN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Counseling Kids and Adults PLLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639958400000",
"number": "1467112342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 974",
"city": "LINDSTROM",
"state": "MN",
"postal_code": "550450974",
"telephone_number": "651-755-4276",
"fax_number": "888-972-5307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12814 LAKE BLVD",
"city": "LINDSTROM",
"state": "MN",
"postal_code": "550459345",
"telephone_number": "651-755-4276",
"fax_number": "888-972-5307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BRADLEY",
"credential": "MA LPCC LADC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-12-20",
"last_updated": "2021-12-20",
"certification_date": "2021-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "3068",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "bclark@counselingkidsandadults.com",
"affiliation": "N",
"endpointDescription": "secure email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "email",
"address_1": "12814 Lake Blvd",
"city": "Lindstrom",
"state": "MN",
"country_code": "US",
"postal_code": "550459345",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lindstrom, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.