Active NPI
Brian R. Clark, L.P.C.
- Professional Counselor
- Sault Sainte Marie, MI
National Provider Identifier
1497907190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401000919
- Practice address
- 623 W Easterday Ave
Sault Sainte Marie, MI 49783-1625 - Phone
- (906) 635-2752
- NPI assigned
- Oct 14, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401000919 | MI | Primary |
| Social Worker | 104100000X | 6801016728 | MI |
Addresses
Primary practice location
623 W Easterday Ave
Sault Sainte Marie, MI 49783-1625
Mailing address
2684 Kavanaugh St
Ossineke, MI 49766-9784
Phone (989) 471-2205
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401000919 | MI | MD | Professional Counselor |
| 6801016728 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454457600000",
"number": "1497907190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2684 KAVANAUGH ST",
"city": "OSSINEKE",
"state": "MI",
"postal_code": "497669784",
"telephone_number": "989-471-2205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "623 W EASTERDAY AVE",
"city": "SAULT SAINTE MARIE",
"state": "MI",
"postal_code": "497831625",
"telephone_number": "906-635-2752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BRIAN",
"middle_name": "R.",
"name_prefix": "Mr.",
"credential": "L.P.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-14",
"last_updated": "2016-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401000919",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801016728",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sault Sainte Marie, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.