Candace Clark, PCC
Individual provider Active NPI Professional Counselor · Berea, OH
NPI 1629327101 · NPPES record last updated Aug 30, 2012
Key facts
- NPI
- 1629327101
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- E.0600652 (OH)
- Practice address
- 202 East Bagley Road
Berea, OH 44017-2058 - Phone
- (800) 234-2006
- NPI assigned
- Aug 30, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2007
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Phoenix Counseling Center LLC
Practice addresses (Care Compare)
33480 Liberty Pkwy
North Ridgeville, OH 44039-2670
Phone (440) 732-5252
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240411004747 | OH | Practitioner - Mental Health Counselor | 5890134753 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.0600652 | OH | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Counseling Center LLC | Professional | Current |
Accepting new patients |
| Phoenix Counseling Center LLC | Past | Accepting new patients |
Locations
6180 Emerald St
North Ridgeville, OH 44039
Phone (216) 327-7372
33480 Liberty Pkwy
North Ridgeville, OH 44039
Phone (440) 732-5252
23550 Center Ridge Rd
Ste 102
Westlake, OH 44145
Phone (440) 732-5252
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E.0600652 | OH | Yes |
Addresses
Primary practice location
202 East Bagley Road
Berea, OH 44017-2058
Mailing address
202 East Bagley Road
Berea, OH 44017-2058
Phone (800) 234-2006
Other providers in Berea, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.