Sean Clark, LPC
Individual provider Active NPI Professional Counselor · Beaverton, OR
NPI 1689078271 · NPPES record last updated Apr 18, 2024
Key facts
- NPI
- 1689078271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- C6270
- Practice address
- 6800 SW 105TH Ave Ste 101
Beaverton, OR 97008-5488 - Phone
- (971) 200-1966
- Fax
- (971) 754-4141
- NPI assigned
- Oct 10, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Higher Ground Counseling Inc | Counselor | Current |
Accepting new patients |
| Janus Youth Programs | Past | Accepting new patients | |
| Janus Youth Programs, Inc. | Past | Accepting new patients |
Locations
6800 SW 105th Ave
Ste 101
Beaverton, OR 97008
Phone (971) 200-1966
113 E Hancock St
Newberg, OR 97132
Phone (971) 200-1966
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C6270 | Yes |
Addresses
Primary practice location
6800 SW 105TH Ave Ste 101
Beaverton, OR 97008-5488
Mailing address
6800 SW 105TH Ave Ste 101
Beaverton, OR 97008-5488
Phone (971) 200-1966
Other practice location 1
113 E Hancock St
Newberg, OR 97132-2821
Phone (971) 200-1966
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500739602 | Medicaid | OR |
Other providers in Beaverton, OR
- Heidi Clark
- Jeff Clark
- Masyn Kathleen Clark
- Meesha Clark
- Sarah Clark
- Mary Jo Kocarnik Clarke
- Cecilia Clasen
- Karen Claud
- Timmi Linn Claveria
- Clearing Skies LLC
All providers in Beaverton, OR · Professional Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.