KARYN E. CLARK (NPI# 1083748404) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083748404 |
| Entity Type | Individual |
| Full Name | KARYN E. CLARK |
| Credential | PHD, ACADC |
| Practice Address |
2215 Blue Gum Ave Modesto CA 95358-1052 |
| Mailing Address |
800 Scenic Dr Modesto CA 95350-6131 |
| Practice Telephone | 2095254536 |
| Practice Fax Number | 2095674740 |
| Mailing Telephone | 2095254536 |
| Mailing Fax Number | 2095674740 |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
CA | Behavioral Health & Social Service Providers | |
| X | 171M00000X | Case Manager/Care Coordinator | CA | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629572698 | Karyn Kelly Clark | Case Manager/Care Coordinator | 625 E Madison Ave Ste 6, Riverton, WY 82501-4712 | 2018-03-22 |
| 1033455068 | Karyn Clark | Case Manager/Care Coordinator | 3960 Walnut Dr, Eureka, CA 95503-8938 | 2012-12-19 |
| Street Address |
2215 BLUE GUM AVE |
| City | MODESTO |
| State | CA |
| Zip Code | 95358-1052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710012489 | Keri Berbena Rodgers | Registered Nurse | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2007-02-22 |
| 1255994745 | Joseph Aaron Quismondo Hernandez | Technician | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2019-04-19 |
| 1073176566 | Ricardo Maravilla-garcia | Technician | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2019-04-19 |
| 1609439199 | Gloria Cecilia Arroyo | Technician | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2019-04-19 |
| 1962863795 | Norma Elena Ramirez | Case Manager/Care Coordinator | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2016-03-07 |
| 1013314574 | Rita Zabrina Preciado | Case Manager/Care Coordinator | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2014-11-29 |
| 1174920607 | Jessica Nicole Van Tuinen | Technician | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2014-11-26 |
| 1235539859 | Lisa Cortez | Social Worker | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2014-09-02 |
| 1851791941 | Jessica Herrera | Counselor | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2014-08-26 |
| 1598194128 | Victoria Galvan | Counselor | 2215 Blue Gum Ave, Modesto, CA 95358-1052 | 2013-11-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902321805 | Cecilia Yolanda Guajardo | Counselor | 2524 Finney Road, Ceres, CA 95358 | 2017-08-11 |
| 1205203049 | Olga Olivia Castillo | Case Manager/Care Coordinator | 1620 Cummings Rd, Modesto, CA 95358 | 2015-08-27 |
| 1174942270 | Rajneel Singh | Case Manager/Care Coordinator | 1524 Radcliffe Ave, Modesto, CA 95358 | 2014-04-16 |
| 1447486139 | Karl David Meabrod | Counselor | 190 E. Hackett Rd., Modesto, CA 95358 | 2009-06-08 |
| 1265634281 | County of Stanislaus | Community/Behavioral Health | 190 Hackett Road, Modesto, CA 95358 | 2007-06-01 |
| 1134250400 | Shelley Marie Southern | Marriage & Family Therapist | 1620 Cummins Drive, Modesto, CA 95358 | 2007-03-08 |
| 1538297973 | County of Stanislaus | Community/Behavioral Health | 251 East Hackett Road, Modesto, CA 95358 | 2007-02-28 |
| 1407347248 | Jamie Lauren Mcgillis | Counselor | 1620 Cummins Dr, Modesto, CA 95358 | 2018-05-29 |
| 1508250135 | Michelle Eldridge | Case Manager/Care Coordinator | 1620 Cummins Drive, Modesto, CA 95358 | 2015-03-20 |
| 1083747604 | Juan Carlos Teran Jr. | Case Manager/Care Coordinator | 1620 Cummins Dr, Modesto, CA 95358 | 2007-03-13 |
| Find all providers in zip 95358 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063055812 | Diana Harrison | Counselor | 1235 Mchenry Ave # A&b, Modesto, CA 95350-5370 | 2019-10-24 |
| 1710468095 | Dominic Maurice Casaca | Counselor | 616 Perfidia Ave, Modesto, CA 95351-4135 | 2018-08-24 |
| 1659867513 | Amalia Tapia | Counselor | 1235 Mchenry Ave Unit A&b, Modesto, CA 95350-5370 | 2018-07-03 |
| 1265934301 | Ben Hopp | Counselor | 123 Mchenry Ave, Modesto, CA 95354-0541 | 2018-03-05 |
| 1447772488 | Selenee Marie Flores | Counselor | 1235 Mchenry Ave # Ab, Modesto, CA 95350-5370 | 2017-07-12 |
| 1801325477 | Holly Elizabeth Moore | Counselor | 2000 W Briggsmore Ave Ste 1, Modesto, CA 95350-3839 | 2017-06-07 |
| 1942737507 | Gloria Edith Robles | Counselor | 3125 Mchenry Ave Ste D, Modesto, CA 95350-1451 | 2017-05-15 |
| 1184088668 | Michelle Lucas | Counselor | 1421 Mosswood Ln, Modesto, CA 95355-1555 | 2016-04-11 |
| 1407229248 | Roy Douglas | Counselor | 1235 Mcherney, A and B, Modesto, CA 95350-9411 | 2015-11-02 |
| 1639541394 | Dynese Lee Addotta | Counselor | 1520 Goldenwood Dr, Modesto, CA 95350-3865 | 2015-10-21 |
| Find all providers in MODESTO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.