Teryl L Clark, LCSW

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5970987-3501 Issued in UT

Practice address

789 Bamberger Dr
Suite a
American Fork, UT 84003-2181

Phone

(801) 915-8792

NPI assigned

Aug 12, 2013

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2017 through Apr 1, 2027

Medicare enrollment (NPD)

Not 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.

• LDS Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Renton, WA
  • NPI 1073726485
  NPD (past)

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376265600000",
    "number": "1588097786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13478 S LONE ROCK",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "84020",
            "telephone_number": "801-915-8792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 BAMBERGER DR",
            "address_2": "SUITE A",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840032181",
            "telephone_number": "801-915-8792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TERYL",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-12",
        "last_updated": "2013-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "5970987-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hunter Barry Clark, DC
• James L Clark, MD
• Jay Austin Clark, M.D.
• Sadie Marie Clark, MSWI
• Stacey Lynne Clark, LCSW
• Sarah J Clasby, PA, MPH, FAMILY MED
• Shannon Francis Clegg, RN, IBCLC
• Wesley Robert Clegg
• Michelle L Clough
• Tennille Cloward, M.D.

• All providers in American Fork, UT
• Professional Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.