Nathaniel P Clark, LCPC-C

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC5420 Issued in ME

Practice address

11 Baxter Blvd
Portland, ME 04101-1801

Phone

(207) 774-8700

Fax

(207) 422-7268

NPI assigned

Mar 4, 2016

Last updated

Jan 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Counseling Center of Nashua IncGroup PAC ID 3274523758, 250 clinicians

Health Affiliates Maine, LLCGroup PAC ID 1951594076, 169 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ccn.nathanielclark@140126.advancedmd-direct.com

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

• Health Affiliates Maine, LLC

  • Community/Behavioral Health Agency
  • Auburn, ME
  • NPI 1932413556
  Medicare reassignment Care Compare group NPD
• The Counseling Center of Nashua Inc

  dba LifeStance Health

  • Clinical Psychologist
  • Nashua, NH
  • NPI 1144275389

  ME, Professional

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1891155792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 BAXTER BLVD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041011801",
            "telephone_number": "207-774-8700",
            "fax_number": "207-422-7268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 BAXTER BLVD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041011801",
            "telephone_number": "207-774-8700",
            "fax_number": "207-422-7268"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Center St",
            "address_2": "Building F",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "ME",
            "postal_code": "042105229",
            "country_code": "US",
            "telephone_number": "207-777-5888",
            "fax_number": "207-777-5802",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1155 Lisbon St",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ME",
            "postal_code": "042405025",
            "country_code": "US",
            "telephone_number": "207-783-9141",
            "fax_number": "207-376-3808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NATHANIEL",
        "middle_name": "P",
        "credential": "LCPC-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-04",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "ME",
            "license": "XL4658",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "CC5420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Ann Clark, LCSW
• Kathryn Alison Clark, LCSW
• Matthew Anthony Clark, DO
• Meagan Jenkins Clark, MD
• Michelle Ruth Clark, PA-C
• Nicole TM Clark, ATC-L
• Troy William Clark, LCSW
• William P Clark
• Beth S Clarke, LCSW
• Rebecca Lynn Clarkin, PMHNP

• Professional Counselor in Portland, ME
• Providers in Portland, ME by specialty
• Professional Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.