Breanne Ariel Clark

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

132 E Broadway Ste 303
Eugene, OR 97401-3154

Phone

(541) 525-4460

Fax

(541) 833-4033

NPI assigned

Jul 20, 2020

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Well Aware Integrative Care LLC

  • Psychiatry Physician
  • Eugene, OR
  • NPI 1801587209
  NPD

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

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705104000000",
    "number": "1619585221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 E BROADWAY STE 303",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013154",
            "telephone_number": "541-525-4460",
            "fax_number": "541-833-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 E BROADWAY STE 303",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013154",
            "telephone_number": "541-525-4460",
            "fax_number": "541-833-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BREANNE",
        "middle_name": "ARIEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-20",
        "last_updated": "2024-01-13",
        "certification_date": "2024-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Springfield (City of Springfield Ambulance)
• Cortnie Ciullo
• Lauren Forrester Clancey, AU.D
• Adam William Clark, PTA
• April Shannon Clark, LPC-ASSOCIATE R7809
• Caitlin Alexandra Clark, BA, CADC I
• Camm D. Clark, LCSW
• Christina Clark
• Crystal L Clark, RC
• Eric Franklin Clark

• Mental Health Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.