Jerod Clark

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

907 W Caddo St
Cleveland, OK 74020-4201

Phone

(918) 607-5576

NPI assigned

Jan 11, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, OK
  • NPI 1497762520
  Medicare reassignment NPD
• Grand Lake Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1356048656
  NPD
• Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cleveland, OK
  • NPI 1396518742
  NPD

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1952015141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 W CADDO ST",
            "city": "CLEVELAND",
            "state": "OK",
            "postal_code": "740204201",
            "telephone_number": "918-607-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 W CADDO ST",
            "city": "CLEVELAND",
            "state": "OK",
            "postal_code": "740204201",
            "telephone_number": "918-607-5576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JEROD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Chambers
• Champion Therapy Services
• Lesta K Cheek, COTA
• CHH Ok, LLC
• Monica Cieminski
• Cleveland Area Hospital Authority
• Cleveland Area Hospital Holdings, Inc.
• Cleveland Area Hospital Holdings, Inc.
• Cleveland Area Hospital Holdings, Inc.
• Cleveland Area Hospital Holdings, Inc.

• Mental Health Counselor in Cleveland, OK
• Providers in Cleveland, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.