MANDY CLARK (NPI# 1316144389) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316144389 |
| Entity Type | Individual |
| Full Name | MANDY CLARK |
| Practice Address |
1030 Ne Couch St. Portland OR 97232 |
| Mailing Address |
1027 E. Burnside St. Portland OR 97214 |
| Practice Telephone | 5032398400 |
| Practice Fax Number | 5032398407 |
| Mailing Telephone | 5032398400 |
| Mailing Fax Number | 5032698407 |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2015-02-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104426261 | Mandy Clark | Nurse Practitioner | 610 Nuckolls Rd, Bolivar, TN 38008-1532 | 2020-10-28 |
| 1861843336 | Mandy Clark | Case Manager/Care Coordinator | 1415 Truxtun Ave, Bakersfield, CA 93301-5215 | 2016-06-27 |
| 1740616846 | Mandy Clark | Nurse Practitioner | 1 Medical Center Blvd, Cookeville, TN 38501-4294 | 2013-09-20 |
| Street Address |
1030 NE COUCH ST. |
| City | PORTLAND |
| State | OR |
| Zip Code | 97232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699169946 | David Poole | Counselor | 1030 Ne Couch St., Portland, OR 97232 | 2015-03-25 |
| 1184017071 | Thomas Everette Imig | Community Health Worker | 1030 Ne Couch St., Portland, OR 97232 | 2015-03-17 |
| 1265825897 | Verlene Rose Baker | Spec/Tech, Pathology | 1030 Ne Couch St., Portland, OR 97232 | 2015-03-06 |
| 1942693502 | Kasie M Cloud | Social Worker | 1030 Ne Couch St., Portland, OR 97232 | 2015-03-06 |
| 1720470529 | Damianna Purple-crow | Counselor | 1030 Ne Couch St., Portland, OR 97232 | 2015-03-03 |
| 1558753731 | Sarah Eve Puskarits | Registered Nurse | 1030 Ne Couch St., Portland, OR 97232 | 2015-02-25 |
| 1346632916 | Jeffrey Ottenbacher | Registered Nurse | 1030 Ne Couch St., Portland, OR 97232 | 2015-02-19 |
| 1770975351 | Jessica Michaels Asuncion | Licensed Practical Nurse | 1030 Ne Couch St., Portland, OR 97232 | 2015-02-19 |
| 1902297526 | Mary Mitchel Darnell | Spec/Tech, Pathology | 1030 Ne Couch St., Portland, OR 97232 | 2015-02-18 |
| 1578954277 | Nina Frick | Social Worker | 1030 Ne Couch St., Portland, OR 97232 | 2015-02-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881293215 | Oregon Change Clinic | Clinic/Center | 650 Ne Holladay Street, Suite 1600, Portland, OR 97232 | 2020-10-17 |
| 1154969947 | Lori Kristen Miracle | Acupuncturist | Kwan Yin Healing Arts Center East Inc, 3115 Ne Sandy Blvd. Suite 231, Portland, OR 97232 | 2019-12-12 |
| 1194285411 | Onampai Modina Soondarotok | Student in an Organized Health Care Education/Training Program | Ipp, Oregon Health & Science University, 2214 Lloyd Center, Portland, OR 97232 | 2019-03-22 |
| 1003399635 | Cathleen Nicole Wenberg | Social Worker | 1839 Ne Couch St, Portland, OR 97232 | 2018-09-10 |
| 1508350760 | Float North | Acupuncturist | 1617 Ne 17th Ave., Portland, OR 97232 | 2018-06-20 |
| 1629560719 | Rachael Lee Walters | Doula | 3005 Ne Hoyt St, Portland, OR 97232 | 2018-06-04 |
| 1225529431 | Jason Sutherland | Social Worker | 707 Ne Couch, Portland, OR 97232 | 2018-05-23 |
| 1770089245 | Richard Farwell Leman | Family Medicine | 800 Ne Oregon St., Suite 772, Portland, OR 97232 | 2018-04-03 |
| 1952803413 | Aleksandra Giedowyn Md PC | Family Medicine | 1923 Ne Broadway Street Suite 2, Portland, OR 97232 | 2018-03-01 |
| 1639680374 | Amanda Matteo | Counselor | 20 Ne 10th Ave, Portland, OR 97232 | 2017-10-20 |
| Find all providers in zip 97232 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477163657 | Kevin Charles Reiser | Counselor | 2318 Ne Martin Luther King Blvd, Portland, OR 97212-3715 | 2020-08-03 |
| 1881203628 | Beau Curtiss | Counselor | 7916 Se Foster Rd Ste 203, Portland, OR 97206-4289 | 2020-07-28 |
| 1851916886 | Jonathan Cross | Counselor | 49 Montrose Ave Apt 3, Portland, ME 04103-2442 | 2020-06-16 |
| 1639703960 | Elizabeth Ann Anderson | Counselor | 1820 Sw Vermont St Ste J, Portland, OR 97219-1945 | 2020-02-25 |
| 1194356618 | Deforrest Kwesi Jackson | Counselor | 122 Ne 122nd Ave Ste 200, Portland, OR 97230-2103 | 2020-02-03 |
| 1760012942 | Jesse Decker | Counselor | 7015 N Boston Ave, Portland, OR 97217-5711 | 2020-01-16 |
| 1740829076 | Ryan Christianson | Counselor | 2707 Ne Flanders St, Portland, OR 97232-3159 | 2020-01-03 |
| 1083264477 | Kayla Rose Paris | Counselor | 420 Cumberland Ave, Portland, ME 04101-2823 | 2019-09-17 |
| 1275193260 | Anna Khval | Counselor | 1500 Se 122nd Ave, Portland, OR 97233-1207 | 2019-06-20 |
| 1841855301 | Portland Opioid Health Home | Counselor | 48 Free St., Mezzanine Level, Portland, ME 04101 | 2019-05-09 |
| Find all providers in PORTLAND | ||||
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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.