MARK CLARK (NPI# 1720119167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720119167 |
| Entity Type | Individual |
| Full Name | MARK CLARK |
| Credential | SUDC |
| Practice Address |
1366 W Indian Hills Dr Unit 69 Saint George UT 84770-1885 |
| Mailing Address |
711 California Ave Libby MT 59923-1903 |
| Practice Telephone | 4062937731 |
| Practice Fax Number | 4062972823 |
| Mailing Telephone | 4062937731 |
| Mailing Fax Number | 4062972823 |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2018-09-20 |
| 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) |
22 | MT | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | 0320372 | 05 | |
| MT | CHIP | 760460 | 01 |
| MT | BLUE CROSS BLUE SHIELD | 0000073691 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912324351 | Mark Clark | Podiatrist | 2300 Coronado Rd, Pueblo, CO 81003-1840 | 2014-03-24 |
| 1710265160 | Mark Clark | Technician, Other | 6646 Highway 50, Gerald, MO 63037-2700 | 2011-08-02 |
| 1215255682 | Mark P Clark | Counselor | 11 Brandywine Dr, Cincinnati, OH 45246-3809 | 2010-05-11 |
| 1609006022 | Mark H. Clark | Pharmacist | 2901 N Dallas Parkway, Suite 420, Plano, TX 75093 | 2009-07-20 |
| 1588856827 | Mark Brian Clark | Registered Nurse | 3420 Box Elder, Evergreen, CO 80439-7841 | 2007-08-10 |
| 1154549061 | Mark W Clark | Nurse Anesthetist, Certified Registered | 1201 First St, Kennett, MO 63857 | 2007-04-23 |
| 1205989605 | Mark Daniel Clark | Anesthesiology | 3735 Norton Hills Rd, Norton Shores, MI 49441-4469 | 2007-01-19 |
| 1407903693 | Mark Allen Clark | Nurse Practitioner | 111 Park Hill Dr # A, Fredericksburg, VA 22401-3357 | 2007-01-03 |
| 1447352828 | Mark Wayne Clark | Dentist | G-3550 Flushing Rd, Flint, MI 48504 | 2006-09-05 |
| 1407958291 | Mark Clark | Family Medicine | 7477 S State Rd, Goodrich, MI 48438-8745 | 2006-09-02 |
| Street Address |
1366 W INDIAN HILLS DR UNIT 69 |
| City | SAINT GEORGE |
| State | UT |
| Zip Code | 84770-1885 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740808500 | Redstone Reference Laboratories Inc | Clinical Medical Laboratory | 556 N Dixie Drive, Suite 2, St George, UT 84770 | 2020-07-08 |
| 1033776315 | Ecko Ashmore | Marriage & Family Therapist | 1173 S. 250 W. Bld 1 Ste 208, St. George, UT 84770 | 2019-05-22 |
| 1740844679 | Amy Darragh | Behavior Technician | 249 E Tabernacle St, Ste 100, St George, UT 84770 | 2019-04-25 |
| 1124598198 | Loren Kyle Gulbranson | Internal Medicine | Dixie Regional Medical Center, 515 South, 300 East, Saint George, UT 84770 | 2018-12-03 |
| 1487150728 | Sound Sleep Medical LLC | Durable Medical Equipment & Medical Supplies | 640 East 700 South Building 2, St. George, UT 84770 | 2018-04-04 |
| 1588162911 | Desert Edge Medical | Family Medicine | 1664 S Dixie Dr Ste D201, St George, UT 84770 | 2018-01-31 |
| 1568981314 | Jeffrey Joseph Peterson | Behavior Technician | 162 N 400 E Ste A-105, St. George, UT 84770 | 2017-09-13 |
| 1992242549 | Zachary Carey | Specialist/Technologist | 1115 W Diamond Valley Dr, Saint George, UT 84770 | 2017-01-20 |
| 1669920427 | Charles Taylor Church | Technician, Other | 474 West 200 East, St. George, UT 84770 | 2016-09-21 |
| 1952755480 | Hollystic Hideaway | Voluntary or Charitable | 1418 W Sunset Blvd. # 2, Saint George, UT 84770 | 2016-04-21 |
| Find all providers in zip 84770 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417428178 | Michael Keenan | Counselor | 1223 S 1280 E, Saint George, UT 84790-8553 | 2018-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518565803 | Nathaniel A Moore | Counselor | 11764 West Aspen Lane, Loa, UT 84747 | 2020-10-09 |
| 1235751587 | Clara Sobral Hinckley | Counselor | 975 S 250 W Apt A, Provo, UT 84601-5991 | 2020-05-09 |
| 1487275855 | Norman Van Bray | Counselor | 260 W North Lane, Holden, UT 84636 | 2020-04-27 |
| 1972133783 | Aspire365, LLC | Counselor | 772 E 8230 S, Sandy, UT 84094-0679 | 2020-01-21 |
| 1851939011 | Shaunell Young | Counselor | 2264 N 2650 E, 2264 N 2650 E, Layton, UT 84040 | 2019-12-18 |
| 1679120729 | Kristen E Tolman | Counselor | 506 Harvest Moon Dr, Pleasant Grove, UT 84062-3663 | 2019-08-23 |
| 1134788060 | Isaac Curtis | Counselor | 523 Heritage Park Blvd Ste 4, Layton, UT 84041-5611 | 2019-06-13 |
| 1689231094 | Chasity Edwards | Counselor | 491 E Riverside Dr Ste 1a, St George, UT 84790-7052 | 2019-05-21 |
| 1841855632 | Kathy Rekoutis | Counselor | 1397 W 8660 S, West Jordan, UT 84088-9115 | 2019-05-07 |
| 1740845858 | Debra Drabner | Counselor | 164 E 5900 S Ste A101, Murray, UT 84107-7279 | 2019-05-03 |
| Find all providers with the same taxonomy | ||||
| City | SAINT GEORGE |
| Zip Code | 84770 |
Please comment or provide details below to improve the information on MARK CLARK.
| 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.