Maria Clark, LIMPH

Individual provider Active NPI Professional Counselor · Bellevue, NE

NPI 1760915656 · NPPES record last updated Jul 26, 2018

Key facts

NPI
1760915656
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
1579 (NE)
Practice address
1620 Wilshire Dr Ste 222
Bellevue, NE 68005
Phone
(402) 536-9568
NPI assigned
Apr 6, 2017
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1579NEMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maria Clark LLC Mental Health Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 1579 NE
Professional Counselor 101YP2500X 1579 NE Yes

Addresses

Primary practice location

1620 Wilshire Dr Ste 222
Bellevue, NE 68005

Mailing address

2613 Blackhawk Dr
Bellevue, NE 68123-3707

Other providers in Bellevue, NE

All providers in Bellevue, NE · Professional Counselor in Nebraska

Sources for this page

Verify at the official NPI Registry.