Jan Christine Clark, TLMHC
Individual provider Active NPI Mental Health Counselor · Fort Madison, IA
NPI 1871363853 · NPPES record last updated Jan 2, 2024
Key facts
- NPI
- 1871363853
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 123568 (IA)
- Practice address
- 509 Avenue F
Fort Madison, IA 52627-2910 - Phone
- (319) 372-3566
- Fax
- (319) 372-8074
- NPI assigned
- Jan 2, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 123568 | IA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optimae Lifeservices, Inc, | Past |
Accepting new patients | |
| Rescare, Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 123568 | IA | Yes |
Addresses
Primary practice location
509 Avenue F
Fort Madison, IA 52627-2910
Mailing address
301 W Burlington Ave
Fairfield, IA 52556-3242
Phone (641) 472-1864
Other providers in Fort Madison, IA
- Jessica Burdette
- Kolleen Burnett
- Mark Stewart Calkins
- Christina Marie Campbell-Oberman
- City of Fort Madison
- Clear View Vision Center, LLC
- Jennifer Cooper
- David R Courtney
- Mike J Crowell
- Cultivate Joy Psychiatry LLC
All providers in Fort Madison, IA · Mental Health Counselor in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.