Active NPI
Daniel W Clark, PHD
- Clinical Psychologist
- Olympia, WA
National Provider Identifier
1619168796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY1791
- Practice address
- 1405 Harrison Ave NW Ste 205
Olympia, WA 98502-5327 - Phone
- (360) 586-8492
- NPI assigned
- Aug 5, 2007
- Last updated
- Aug 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY1791 | WA | Primary |
Addresses
Primary practice location
1405 Harrison Ave NW Ste 205
Olympia, WA 98502-5327
Mailing address
1405 Harrison Ave NW Ste 205
Olympia, WA 98502-5327
Phone (360) 586-8492
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY1791 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186272000000",
"number": "1619168796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1405 HARRISON AVE NW STE 205",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985025327",
"telephone_number": "360-586-8492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 HARRISON AVE NW STE 205",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985025327",
"telephone_number": "360-586-8492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DANIEL",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-05",
"last_updated": "2007-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY1791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.