Cristina Edith Clarke, M.S

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

143447 Issued in CA

Practice address

714 W Olympic Blvd Ste 743
Los Angeles, CA 90015-1668

Phone

(310) 712-3411

Fax

(213) 749-1875

NPI assigned

Jan 31, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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.

• Fig Tree Psychology Center

  • Mental Health Counselor
  • Los Angeles, CA
  • NPI 1699118646
  NPD (past)

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

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1477316743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 CRESTWOLD AVE",
            "city": "VIEW PARK",
            "state": "CA",
            "postal_code": "900431823",
            "telephone_number": "310-425-4161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 W OLYMPIC BLVD STE 743",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900151668",
            "telephone_number": "310-712-3411",
            "fax_number": "213-749-1875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3485 Rosewood Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900662242",
            "country_code": "US",
            "telephone_number": "310-425-4161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "CRISTINA",
        "middle_name": "EDITH",
        "name_prefix": "Mrs.",
        "credential": "M.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-31",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "15341",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "143447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stevan Ray Clark, M.D.
• Tiffany Tenise Clark
• Tracy Clark Jr.
• William Deangelo Clark
• Britney Shamay Clarke
• Johan Alexander Clarke, MD
• Kalaki Marks Clarke, M.D.
• Kylar Dyoni Clarke
• Lenorre Ruth Clarke, M.D.
• Lillie Mae Clarke

• Mental Health Counselor in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.