Marie Clark, M.A., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

166000714 Issued in IL

Practice address

141 Market PL
Suite 206
Fairview Heights, IL 62208-2034

Phone

(314) 644-1557

Fax

(314) 453-4942

NPI assigned

Jan 23, 2012

Last updated

Jan 23, 2012By the provider in NPPES

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327276800000",
    "number": "1649541673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12685 DORSETT RD",
            "address_2": "#339",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630432100",
            "telephone_number": "314-644-1557",
            "fax_number": "314-453-4942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 MARKET PL",
            "address_2": "SUITE 206",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082034",
            "telephone_number": "314-644-1557",
            "fax_number": "314-453-4942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARIE",
        "credential": "M.A., LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-23",
        "last_updated": "2012-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166000714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Fairview Heights, IL
• Providers in Fairview Heights, IL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; 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.