Active NPI
Richard Clark, MFT
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1568589067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 44345
- Practice address
- 4211 Avalon Blvd
Los Angeles, CA 90011-5622 - Phone
- (323) 432-5185
- Fax
- (323) 432-5086
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 44345 | CA | Primary |
Addresses
Primary practice location
4211 Avalon Blvd
Los Angeles, CA 90011-5622
Mailing address
704 W 40TH St Apt 1
San Pedro, CA 90731-7150
Phone (310) 831-5134
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44345 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285286400000",
"number": "1568589067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "704 W 40TH ST APT 1",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907317150",
"telephone_number": "310-831-5134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4211 AVALON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900115622",
"telephone_number": "323-432-5185",
"fax_number": "323-432-5086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RICHARD",
"name_prefix": "Mr.",
"credential": "MFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2010-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "44345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.