Jeannine Pearce Clark

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

22609 Issued in FL

Practice address

271 Imperial LN
Lauderdale by the Sea, FL 33308-5924

Phone

(954) 478-9328

NPI assigned

Oct 24, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Triumph Mental Health Counseling, LLC

  • Mental Health Counselor
  • Lauderdale by the Sea, FL
  • NPI 1245037399
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1518684232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 IMPERIAL LN",
            "city": "LAUDERDALE BY THE SEA",
            "state": "FL",
            "postal_code": "333085924",
            "telephone_number": "954-478-9328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 IMPERIAL LN",
            "city": "LAUDERDALE BY THE SEA",
            "state": "FL",
            "postal_code": "333085924",
            "telephone_number": "954-478-9328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JEANNINE",
        "middle_name": "PEARCE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-24",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "22609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46-3082537",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101YM0800X",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Stephen Breza Jr., MD
• Center for Intergrative Wellness
• Challenges Conquered Counseling and Consulting, LLC
• Myriam Cyndy Cherubin
• Ashley Chess, PHARMD
• Jordan Clayborne, PT
• Clint C Comunale, LCSW
• Craig Depodesta, DO, PA
• Mark A Curatolo
• Curemed

• Mental Health Counselor in Lauderdale by the Sea, FL
• Providers in Lauderdale by the Sea, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.