Carly A Clark, PSS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

THW000107924 Issued in OR

Practice address

620 NE 2ND St
Gresham, OR 97030-7514

Phone

(971) 274-3757

NPI assigned

Mar 16, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1689375529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 SW MADISON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051715",
            "telephone_number": "503-224-1044",
            "fax_number": "503-621-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 NE 2ND ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307514",
            "telephone_number": "971-274-3757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CARLY",
        "middle_name": "A",
        "credential": "PSS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "THW000107924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen K. Choong, M.D.
• Kristan Chow
• May-Lynn Chu, D.O
• Emily Rayleen Clapp
• Bethaney Clark
• Frances Leanne Clark, MA
• Jessica Clark
• Kathryn Anne Clark, MC, LPC
• Kelly Clark, BS, CADC I
• Nicklaus Clark, LPC, LMHC

• Peer Specialist in Gresham, OR
• Providers in Gresham, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; 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.