JACK CLARK (NPI# 1477799112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477799112 |
| Entity Type | Individual |
| Full Name | JACK CLARK |
| Practice Address |
4411 N Cedar Ave Fresno CA 93726-2538 |
| Mailing Address |
830 West Ave Sanger CA 93657-2849 |
| Practice Telephone | 5592481548 |
| Practice Fax Number | 2292481530 |
| Mailing Telephone | 5592481548 |
| Mailing Fax Number | 5592481530 |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2008-12-31 |
| Gender Code | M |
| 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 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083840342 | Jack R Clark | Dentist | 1856 Lancaster Rd, Homewood, AL 35209-4114 | 2009-06-01 |
| 1265571608 | Jack Douglas Clark | Ophthalmology | 7112 N Fresno St, Suite 100, Fresno, CA 93720-2940 | 2007-02-05 |
| 1346320140 | Jack Prow Clark | Family Medicine | 518 Ems D15 Ln, Syracuse, IN 46567-8026 | 2006-10-16 |
| 1306824016 | Jack Crowley Clark Sr. | Radiology | 1431 Centerpoint Blvd, Teamhealth Radiology Ste 100, Knoxville, TN 37932-1984 | 2006-01-03 |
| 1902881014 | Jack J Clark | Chiropractor | 6015 E State Blvd, Fort Wayne, IN 46815-7638 | 2005-12-12 |
| 1841311487 | Jack Malcolm Clark IIi | Social Worker | 7711 Madonna, San Antonio, TX 78216-6620 | 2007-04-02 |
| 1902992837 | Jack O. Clark | Internal Medicine | 450 E Main St, Rexburg, ID 83440 | 2006-10-05 |
| 1427092857 | Jack C Clark | Family Medicine | 103 Midlake Dr, Knoxville, TN 37918-3039 | 2006-06-15 |
| 1588616882 | Jack Lewis Clark | Oral & Maxillofacial Surgery | 21700 Northwestern Hwy, Suite 1290, Southfield, MI 48075-4906 | 2006-05-16 |
| 1073563847 | Jack Clark | Internal Medicine | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2006-05-11 |
| Street Address |
4411 N CEDAR AVE |
| City | FRESNO |
| State | CA |
| Zip Code | 93726-2538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487838470 | David Bethea | Counselor | 4411 N Cedar Ave, Fresno, CA 93726-2538 | 2007-12-26 |
| 1134690357 | Justin Gardner | Counselor | 4411 N Cedar Ave, Fresno, CA 93726-2538 | 2018-12-16 |
| 1821547373 | Darren Michael Kidd | Counselor | 4411 N Cedar Ave, Suite 108, Fresno, CA 93726-2538 | 2016-09-26 |
| 1447709993 | Tracy Lynn Mcdonell | Counselor | 4411 N Cedar Ave, Suite 108, Fresno, CA 93726-2538 | 2016-09-26 |
| 1285090985 | Gabriela Garcia | Counselor | 4411 N Cedar Ave, Fresno, CA 93726-2538 | 2016-01-11 |
| 1730544222 | Frances Sanchez | Counselor | 4411 N Cedar Ave, #108, Fresno, CA 93726-2538 | 2015-12-28 |
| 1962881474 | Gabriel Thomas Nabarrete | Counselor | 4411 N Cedar Ave, Fresno, CA 93726-2538 | 2015-05-29 |
| 1427440205 | Willie Turner Jr. | Counselor | 4411 N Cedar Ave, 108, Fresno, CA 93726-2538 | 2015-03-03 |
| 1407244833 | Monalissa Torres I | Counselor | 4411 N Cedar Ave, Suite 108, Fresno, CA 93726-2538 | 2015-01-08 |
| 1689019143 | Cristina Flores | Counselor | 4411 N Cedar Ave, Suite 108, Fresno, CA 93726-2538 | 2013-05-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528520814 | Tania Grijalva Miranda | Behavior Technician | 4910 E. Ashland Ave, Fresno, CA 93726 | 2019-04-04 |
| 1790249894 | Lags Spine and Sportscare Medical Centers, Inc. | Psychologist | 3751 E Shields Avenue, Fresno, CA 93726 | 2019-01-23 |
| 1013481100 | Jill A Perricone | Respiratory Therapist, Registered | 4785 N First St, Fresno, CA 93726 | 2019-01-11 |
| 1285108399 | Leann Lokelani Benton | Respiratory Therapist, Registered | 4785 N. First St, Fresno, CA 93726 | 2019-01-11 |
| 1548745912 | Alina Gonzalez | Counselor | 4440 N. First St., Fresno, CA 93726 | 2018-10-01 |
| 1336622067 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 3751 E Shields Ave, Fresno, CA 93726 | 2018-09-10 |
| 1730676206 | Joanne K Groves | Counselor | 3636 N. First Street, St. 123, Fresno, CA 93726 | 2018-04-19 |
| 1356865679 | Fresno Mental Psychological Health Services, P.C. | Clinic/Center | 4021 N Fresno Street, Ste. 101, Fresno, CA 93726 | 2017-07-28 |
| 1205358819 | Jetinder Singh Ghag | Counselor | 3636 N.first St # 135 and 154, Fresno, CA 93726 | 2017-07-14 |
| 1164897328 | Karam Um Dds Inc | Dentist | 4747 N. First St. #174, Fresno, CA 93726 | 2015-12-14 |
| Find all providers in zip 93726 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164022976 | Denise Renee Hands | Counselor | 4604 E Terrace Ave, Fresno, CA 93703-2079 | 2020-10-30 |
| 1649807694 | Debbie Jeneen Darden | Counselor | 891 W Kearney Blvd, Fresno, CA 93706-2514 | 2020-03-26 |
| 1205466802 | Elizabeth C Esqueda | Counselor | 804 S Parallel Ave, Fresno, CA 93721-2404 | 2020-01-22 |
| 1295378446 | Caussaundra Maria Dominguez | Counselor | 2772 S Martin Luther King, Fresno, CA 93706 | 2019-10-21 |
| 1881244945 | Aurelio Mendoza | Counselor | 1414 W. Kearney Blvd, Fresno, CA 93706 | 2019-09-19 |
| 1356994909 | Joaquin Sanchez | Counselor | Quest House 2731 W Olive Ave, Fresno, CA 93728 | 2019-07-23 |
| 1003374539 | Jasmine Elizabeth Flores | Counselor | 2772 S Martin Luther King Junior Blvd, Fresno, CA 93706 | 2019-03-04 |
| 1104397348 | Brian K Bradley | Counselor | 2212 N Winery Ave, Fresno, CA 93703-2896 | 2018-12-16 |
| 1063982049 | Bruno Sivongxay | Counselor | 2772 South Martin L King Jr Blvd, Fresno, CA 93706 | 2018-12-03 |
| 1831669951 | Ashlee Faith Vasquez | Counselor | 1900 N Gateway Blvd Ste 100, Fresno, CA 93727-1622 | 2018-12-01 |
| Find all providers in FRESNO | ||||
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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.