Active NPI
Carly Rayne Clark, LPC
- Mental Health Counselor
- Oregon City, OR
National Provider Identifier
1831972546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- C3778
- Practice address
- 15363 Loder Rd
Oregon City, OR 97045-9092 - Phone
- (503) 705-7912
- NPI assigned
- Aug 16, 2023
- Last updated
- Aug 16, 2023
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | C3778 | OR | Primary |
Addresses
Primary practice location
15363 Loder Rd
Oregon City, OR 97045-9092
Mailing address
15363 Loder Rd
Oregon City, OR 97045-9092
Phone (503) 705-7912
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C3778 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692144000000",
"number": "1831972546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15363 LODER RD",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970459092",
"telephone_number": "503-705-7912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15363 LODER RD",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970459092",
"telephone_number": "503-705-7912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CARLY",
"middle_name": "RAYNE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-16",
"last_updated": "2023-08-16",
"certification_date": "2023-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "C3778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oregon City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.