Jessica Leann Clark

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

504 N Grand Traverse St
Flint, MI 48503-2536

Phone

(810) 487-4676

Fax

(810) 496-4295

NPI assigned

Feb 13, 2024

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Great Lakes Recovery Mission, LLC

  • Substance Abuse Rehabilitation Facility
  • Flint, MI
  • NPI 1184111528
  NPD

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1508621160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5099 W FARRAND RD",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "484208215",
            "telephone_number": "586-491-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 N GRAND TRAVERSE ST",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485032536",
            "telephone_number": "810-487-4676",
            "fax_number": "810-496-4295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JESSICA",
        "middle_name": "LEANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Clark, LLMSW
• Emili Clark, RN
• Emily Ann Clark
• Francine Marie Clark, BA, LBSW
• Ivy Michelle Clark
• Kimberly Clark, P.T.
• Mark Wayne Clark, DDS
• Natalie Clark
• Nelson Clark Jr.
• Brianna Clarke

• Addiction (Substance Use Disorder) Counselor in Flint, MI
• Providers in Flint, MI by specialty
• Addiction (Substance Use Disorder) Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.