Active NPI
Fanchon Marie Clark, M.A., LPC, CAADC
- Professional Counselor
- Grand Rapids, MI
National Provider Identifier
1689190290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401009405
- Practice address
- 622 Griggs St SE
Grand Rapids, MI 49507-2644 - Phone
- (616) 901-1650
- NPI assigned
- Aug 15, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401009405 | MI | Primary |
Addresses
Primary practice location
622 Griggs St SE
Grand Rapids, MI 49507-2644
Mailing address
622 Griggs St SE
Grand Rapids, MI 49507-2644
Phone (616) 901-1650
Other names 1
- Fanchon Clark Harvey
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401009405 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1689190290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "622 GRIGGS ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495072644",
"telephone_number": "616-901-1650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 GRIGGS ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495072644",
"telephone_number": "616-901-1650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "FANCHON",
"middle_name": "MARIE",
"credential": "M.A., LPC, CAADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-15",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401009405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "FANCHON",
"last_name": "HARVEY",
"middle_name": "CLARK",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.