Jessica L.C. Clark, LMHC, CCSOTS, TF-CBT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

15397 Issued in FL

Practice address

396 Washington St # 266
Wellesley Hills, MA 02481-6209

Phone

(855) 438-8331

NPI assigned

Aug 11, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jessica.clark@361010828083204.direct.elationemr.com

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

{
    "created_epoch": "1344643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1659628493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "396 WASHINGTON ST # 266",
            "city": "WELLESLEY HILLS",
            "state": "MA",
            "postal_code": "024816209",
            "telephone_number": "855-438-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 WASHINGTON ST # 266",
            "city": "WELLESLEY HILLS",
            "state": "MA",
            "postal_code": "024816209",
            "telephone_number": "855-438-8331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 E Sheridan Rd",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329013122",
            "country_code": "US",
            "telephone_number": "321-722-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JESSICA",
        "middle_name": "L.C.",
        "credential": "LMHC, CCSOTS, TF-CBT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-11",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH 11318",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "15397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Cardinal, OTR
• Brant Christian Carter, LIC. AC., DIPL. O.M.
• Francis S. Caruso, ED.D.
• Eumene Ching, M.D.
• Christopher J. Davidson, M.D., LLC
• Michelle Clark, PHD
• CNS Clinicians, P.C.
• Pamela Marie Cobey, RNPC, RNNP
• Suzanne Lee Cooley, MSN, RN, CS
• Nancy A Crowley, RN, CPNP

• Mental Health Counselor in Wellesley Hills, MA
• Providers in Wellesley Hills, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.