Active NPI
Glen Antonio Clark III
- Addiction (Substance Use Disorder) Counselor
- San Francisco, CA
National Provider Identifier
1952585218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 1301 Pierce St.
San Francisco, CA 94115 - Phone
- (415) 563-8200
- Fax
- (510) 644-2044
- NPI assigned
- Dec 21, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
1301 Pierce St.
San Francisco, CA 94115
Mailing address
1153 Oak St.
San Francisco, CA 94117
Phone (415) 431-9000
Other practice location 1
900 Laurel Ave
San Mateo, CA 94401-4211
Phone (650) 347-8088
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734393600000",
"number": "1952585218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1153 OAK ST.",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "94117",
"telephone_number": "415-431-9000",
"fax_number": "415-431-1813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 PIERCE ST.",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "94115",
"telephone_number": "415-563-8200",
"fax_number": "510-644-2044"
}
],
"practiceLocations": [
{
"address_1": "900 Laurel Ave",
"address_purpose": "LOCATION",
"city": "San Mateo",
"state": "CA",
"postal_code": "944014211",
"country_code": "US",
"telephone_number": "650-347-8088",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLARK",
"first_name": "GLEN",
"middle_name": "ANTONIO",
"name_prefix": "Mr.",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-21",
"last_updated": "2024-12-17",
"certification_date": "2024-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.