Caitlin Alexandra Clark, BA, CADC I

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

149 W 12TH Ave
Eugene, OR 97401-6215

Phone

(541) 484-9274

Fax

(541) 484-5021

NPI assigned

Sep 24, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

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

{
    "created_epoch": "1348444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351555200000",
    "number": "1992056402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1199 N TERRY ST",
            "address_2": "180",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974021459",
            "telephone_number": "541-968-4282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 W 12TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974016215",
            "telephone_number": "541-484-9274",
            "fax_number": "541-484-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CAITLIN",
        "middle_name": "ALEXANDRA",
        "name_prefix": "Miss",
        "credential": "BA, CADC I",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-24",
        "last_updated": "2012-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cortnie Ciullo
• Lauren Forrester Clancey, AU.D
• Adam William Clark, PTA
• April Shannon Clark, LPC-ASSOCIATE R7809
• Breanne Ariel Clark
• Camm D. Clark, LCSW
• Christina Clark
• Crystal L Clark, RC
• Eric Franklin Clark
• Georganne M. Clark, C.P.M.

• Mental Health Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; 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.