Active NPI
Christopher Tad Clark, M.ED.
- Professional Counselor
- Rock Springs, WY
National Provider Identifier
1992053474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1198
- Practice address
- 1471 Dewar Dr Ste 204
Rock Springs, WY 82901-5826 - Phone
- (307) 630-3466
- Fax
- (307) 316-0228
- NPI assigned
- Aug 15, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC-1198 | WY | |
| Professional Counselor | 101YP2500X | 1198 | WY | Primary |
Addresses
Primary practice location
1471 Dewar Dr Ste 204
Rock Springs, WY 82901-5826
Mailing address
4000 Dewar Dr
Rock Springs, WY 82901-6218
Phone (307) 382-3010
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-1198 | WY | MD | Mental Health Counselor |
| 1198 | WY | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellness Associates, LLC | Past | Accepting new patients | |
| Sound Minds LLC | Past | Accepting new patients | |
| Family Dynamics Counseling, Inc | Professional | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Community/Behavioral Health Agency
- Rock Springs, WY
- NPI 1639547193
-
- Psychiatric/Mental Health Nurse Practitioner
- Salt Lake City, UT
- NPI 1093439655
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588032000000",
"number": "1992053474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 DEWAR DR",
"city": "ROCK SPRINGS",
"state": "WY",
"postal_code": "829016218",
"telephone_number": "307-382-3010",
"fax_number": "307-382-6881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1471 DEWAR DR STE 204",
"city": "ROCK SPRINGS",
"state": "WY",
"postal_code": "829015826",
"telephone_number": "307-630-3466",
"fax_number": "307-316-0228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHRISTOPHER",
"middle_name": "TAD",
"name_prefix": "Mr.",
"credential": "M.ED.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-15",
"last_updated": "2020-04-28",
"certification_date": "2020-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WY",
"license": "LPC-1198",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WY",
"license": "1198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rock Springs, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.