Marylyn Ann Clark, PH D

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT0053 Issued in AZ

Practice address

222 West Gurley St. Suite 105
Prescott, AZ 86301-3244

Phone

(928) 778-1806

Fax

(928) 541-9308

NPI assigned

Jan 25, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372723200000",
    "number": "1528114451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10246",
            "address_2": "PRESCOTT",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040246",
            "telephone_number": "928-778-1806",
            "fax_number": "928-541-5308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 WEST GURLEY ST. SUITE 105",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863013244",
            "telephone_number": "928-778-1806",
            "fax_number": "928-541-9308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARYLYN",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2013-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC11094",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "AZ",
            "license": "LMFT0053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS",
            "identifier": "EIN203600957",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Allen Cirelli, M.D
• Clarity Lab LLC
• John Clarizio, LMSW
• Jessica Lee Clark, PT, DPT
• Joseph Brady Clark, PTA
• William Clark
• Catherine Elizabeth Clark/Verlinde, L.M.T.
• Kathleen Carey Clarkin-Dedio, DC
• Claussen Collaborative Medical Clinic LLC
• Sarah Beth Claussen, FNP-C

• Marriage & Family Therapist in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Marriage & Family Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2013; 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.