Elyssa F Clark, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-39650 Issued in CO

Practice address

270 E 8TH Ave Ste 206
Durango, CO 81301-5708

Phone

(970) 769-0131

NPI assigned

Sep 3, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Cairn Behavioral Services

  • Behavior Analyst
  • Durango, CO
  • NPI 1699621151
  NPD Authorized official
• La Plata Family Counseling, PLLC

  • Mental Health Counselor
  • Durango, CO
  • NPI 1700436409

  Single Specialty

  NPD

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

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1972151900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 E 2ND AVE",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813014629",
            "telephone_number": "303-968-4882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 E 8TH AVE STE 206",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015708",
            "telephone_number": "970-769-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELYSSA",
        "middle_name": "F",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-03",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": "CO",
            "license": "1-19-39650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "info@laplatafamily.com",
            "affiliation": "N",
            "address_1": "270 E 8th Ave Ste 206",
            "city": "Durango",
            "state": "CO",
            "country_code": "US",
            "postal_code": "813015708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gregory Churchill, DO
• Richard Dean Cimaglia, PT
• Jay R Ciotti, MD
• Suzanne Renee Lafex Ciotti, MD
• David Cisneros
• Jonathan Clark
• Cameron Levi Clarke, MD
• Laura Clarke
• Andrew W Clarkinson, DO
• Erin Gray Clarkinson, DO

• All providers in Durango, CO
• Behavior Analyst in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; 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.