Active NPI
Ollie Bruce Clark, L.M.F.T.
- Marriage & Family Therapist
- Beaumont, CA
National Provider Identifier
1619201159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC 18786
- Practice address
- 136 E 6TH St
Beaumont, CA 92223-2146 - Phone
- (951) 845-3588
- NPI assigned
- Oct 1, 2009
- 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 | MFC 18786 | CA | Primary |
Addresses
Primary practice location
136 E 6TH St
Beaumont, CA 92223-2146
Mailing address
136 E 6TH St
Beaumont, CA 92223-2146
Phone (951) 845-3588
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC 18786 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254355200000",
"number": "1619201159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 E 6TH ST",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922232146",
"telephone_number": "951-845-3588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 E 6TH ST",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922232146",
"telephone_number": "951-845-3588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "OLLIE",
"middle_name": "BRUCE",
"name_prefix": "Mr.",
"credential": "L.M.F.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-01",
"last_updated": "2009-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC 18786",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.