Active NPI
Adria Michelle Clark, LLMSW
- Clinical Social Worker
- Tecumseh, MI
National Provider Identifier
1760630875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801090664
- Practice address
- 500 E Pottawatamie St
Tecumseh, MI 49286-2018 - Phone
- (517) 424-3337
- NPI assigned
- Sep 3, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801090664 | MI | Primary |
Addresses
Primary practice location
500 E Pottawatamie St
Tecumseh, MI 49286-2018
Mailing address
1 Seagate Ste 800
Toledo, OH 43604-1558
Phone (419) 824-7250
Other practice location 1
818 Riverside Ave
Adrian, MI 49221-1446
Phone (517) 423-3887
Other practice location 2
502 E Cummins St
Tecumseh, MI 49286-2074
Phone (517) 423-3887
Other practice location 3
1001 S Raisinville Rd
Monroe, MI 48161-9754
Phone (734) 243-7340
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 383049015 | Other | MI | BEACON HEALTH OPTIONS |
| 383049015 | Other | MI | MAGELLAN BEHAVIORAL OF MICHIGAN |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1760630875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 SEAGATE STE 800",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436041558",
"telephone_number": "419-824-7250",
"fax_number": "419-824-7359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E POTTAWATAMIE ST",
"city": "TECUMSEH",
"state": "MI",
"postal_code": "492862018",
"telephone_number": "517-424-3337"
}
],
"practiceLocations": [
{
"address_1": "818 Riverside Ave",
"address_purpose": "LOCATION",
"city": "Adrian",
"state": "MI",
"postal_code": "492211446",
"country_code": "US",
"telephone_number": "517-423-3887",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "502 E Cummins St",
"address_purpose": "LOCATION",
"city": "Tecumseh",
"state": "MI",
"postal_code": "492862074",
"country_code": "US",
"telephone_number": "517-423-3887",
"fax_number": "517-423-9433",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1001 S Raisinville Rd",
"address_purpose": "LOCATION",
"city": "Monroe",
"state": "MI",
"postal_code": "481619754",
"country_code": "US",
"telephone_number": "734-243-7340",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLARK",
"first_name": "ADRIA",
"middle_name": "MICHELLE",
"name_prefix": "Ms.",
"credential": "LLMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-03",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801090664",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEACON HEALTH OPTIONS",
"identifier": "383049015",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN BEHAVIORAL OF MICHIGAN",
"identifier": "383049015",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tecumseh, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.