Gregory Allen Clark – Marriage & Family Therapist

Key facts

NPI: 1548736622
Entity type: Individual (NPI type 1)
Primary specialty: Marriage & Family Therapist 106H00000X
License: 093800 (IA)
Practice address: 1150 5TH St Ste 270
Coralville, IA 52241-2933
Phone: (319) 804-9312
NPI assigned: Oct 16, 2018
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

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.

Alli Center LLC Clinical Social Worker · Coralville, IA · NPI 1699286427

NPD (past) MARRIAGE & FAMILY THERAPIST

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
093800	IA	MD	Marriage & Family Therapist

Practice roles

Organization	Specialty	Status	New patients
Alli Center LLC	Marriage & Family Therapist	Past since Jan 1, 2018	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Marriage & Family Therapist Group: 193400000X SINGLE SPECIALTY GROUP	106H00000X	093800	IA	Yes

Addresses

Primary practice location

1150 5TH St Ste 270
Coralville, IA 52241-2933

Mailing address

1150 5TH St Ste 270
Coralville, IA 52241-2933
Phone (319) 804-9312

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 16, 2018.

{
    "created_epoch": "1539648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539648000000",
    "number": "1548736622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 5TH ST STE 270",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412933",
            "telephone_number": "319-804-9312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 5TH ST STE 270",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412933",
            "telephone_number": "319-804-9312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GREGORY",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-16",
        "last_updated": "2018-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "IA",
            "license": "093800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coralville, IA

All providers in Coralville, IA · Marriage & Family Therapist in Iowa

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.