Mikaela Kurin Clark, PSY

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

2110 Los Feliz St Unit 2072
Las Vegas, NV 89156-8026

Phone

(702) 808-9204

NPI assigned

Feb 22, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Together We Stand Behavioral Health

  • Behavior Analyst
  • Las Vegas, NV
  • NPI 1760908719
  NPD (past)

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519257600000",
    "number": "1902307242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5057 GABLE CREST CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891413880",
            "telephone_number": "808-342-7392",
            "fax_number": "702-992-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 LOS FELIZ ST UNIT 2072",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891568026",
            "telephone_number": "702-808-9204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MIKAELA",
        "middle_name": "KURIN",
        "credential": "PSY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-22",
        "last_updated": "2018-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NV",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NV",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marquajah Shaprice Clark
• Marybeth Clark, MS, RD
• Melissa Clark
• Michael Clark
• Michelle Clark, M.S., CF-SLP
• Monika Katarzyna Clark, MA, MS, BCBA, LBA
• Monique Clark
• Nancy J Clark, MS
• Nathan Stephan Clark, DO
• Nefertiti Clark

• Student in an Organized Health Care Education/Training Program in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Student in an Organized Health Care Education/Training Program in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.