Kimberly Sue Clark, QMHP

Primary specialty

CounselorTaxonomy code 101Y00000X

License

R6418 Issued in OR

Practice address

905 Main St Ste 512
Klamath Falls, OR 97601-6062

Phone

(541) 591-9392

Fax

(541) 833-0934

NPI assigned

Apr 21, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Kim Dutton Former name

Medicare fee-for-service enrollment

Enrolled in OR

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

Marriage and Family Therapist

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Klamath Counseling Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Klamath Falls, OR
  • NPI 1063070779
  NPD

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1508210915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 ADDISON ST",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976012504",
            "telephone_number": "541-591-9392",
            "fax_number": "541-833-0934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 MAIN ST STE 512",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976016062",
            "telephone_number": "541-591-9392",
            "fax_number": "541-833-0934"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1741 Austin St",
            "address_purpose": "LOCATION",
            "city": "Klamath Falls",
            "state": "OR",
            "postal_code": "976034621",
            "country_code": "US",
            "telephone_number": "541-851-6156",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2545 N Eldorado Ave",
            "address_purpose": "LOCATION",
            "city": "Klamath Falls",
            "state": "OR",
            "postal_code": "976016423",
            "country_code": "US",
            "telephone_number": "541-883-3471",
            "fax_number": "541-883-3524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "QMHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-21",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "17-04-02",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": "R6418",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114058898",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "DUTTON",
            "credential": "LMFT ASSOCIATE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Suvendrini H. C. Christopher-Schuhmann, LPC
• Jeffrey William Chudoba, MD
• Stacy Aline Clair-Johnson
• Brittany Clark
• George Wesley Clark, CRM
• Acacia Teresa Clausing, PSS,YSS,CRM
• Colleen Clemens, QMHA
• Kristen Lee Clemens
• Xander Mathis Clements
• Titia Clouse

• Counselor in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.