Active NPI
Paula C. Clark, M.A.
- Marriage & Family Therapist
- Tustin, CA
National Provider Identifier
1790906824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- M 14545
- Practice address
- 250 W Main St
Suite 201
Tustin, CA 92780-7724 - Phone
- (714) 730-7885
- Fax
- (714) 289-0524
- NPI assigned
- May 2, 2007
- Last updated
- Jun 2, 2009
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | M 14545 | CA | Primary |
Addresses
Primary practice location
250 W Main St
Suite 201
Tustin, CA 92780-7724
Mailing address
250 W Main St
Suite 201
Tustin, CA 92780-7724
Phone (714) 730-7885
Other names 1
- Ms. Paula C. Clark
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 31, 2025 through May 31, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M 14545 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243900800000",
"number": "1790906824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 W MAIN ST",
"address_2": "SUITE 201",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927807724",
"telephone_number": "714-730-7885",
"fax_number": "714-289-0502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 W MAIN ST",
"address_2": "SUITE 201",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927807724",
"telephone_number": "714-730-7885",
"fax_number": "714-289-0524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "PAULA",
"middle_name": "C.",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2009-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "M 14545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "PAULA",
"last_name": "CLARK",
"middle_name": "C.",
"prefix": "MS.",
"credential": "M.F.T.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.