JESSE WAYNE CLARK (NPI# 1730517087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730517087 |
| Entity Type | Individual |
| Full Name | JESSE WAYNE CLARK |
| Credential | LPCC |
| Practice Address |
65 Grady Ct Dayton OH 45409 |
| Mailing Address |
5400 Edalbert Dr Cincinnati OH 45239-7604 |
| Practice Telephone | 9374164031 |
| Mailing Telephone | 9374164031 |
| Mailing Fax Number | 9375341347 |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2018-08-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
E.1600066 | OH | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
C.1200356 | OH | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 30 Overbrook Dr Ste C, Monroe, OH 450501168 | 5135395250 | 5135395371 |
| 65 Grady Ct, Dayton, OH 454091151 | 9374164031 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699323931 | Jesse Clark | Occupational Therapy Assistant | 3485 Windsor Ave, Dubuque, IA 52001-1329 | 2019-08-29 |
| 1043721129 | Jesse Kay Clark | Physician Assistant | 800 5th Ave Ste 300, Fort Worth, TX 76104-7303 | 2017-10-17 |
| 1154642585 | Jesse N Clark | Family Medicine | 10122 E. 10th Street, Suite 100, Indianapolis, IN 46229-2697 | 2010-06-21 |
| 1811166572 | Jesse Lawton Clark | Internal Medicine | 5767 W Century Blvd, Suite 200, Los Angeles, CA 90045-5632 | 2008-02-27 |
| 1376729756 | Jesse D Clark | Dentist | 1611 Greenfield St, Wilmington, NC 28401-6455 | 2008-01-15 |
| Street Address |
65 GRADY CT |
| City | DAYTON |
| State | OH |
| Zip Code | 45409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487276457 | Matthew R Schaeffer | Surgery | 128 E Apple St., Wche 7th Floor, Dayton, OH 45409 | 2020-05-13 |
| 1699237545 | Elizabeth Joan Hudson | Student in an Organized Health Care Education/Training Program | 1 Wyoming Street Miami Valley Hospital Medical Educatio, Dayton, OH 45409 | 2019-04-01 |
| 1760941066 | Courtney Lyn Johnson | Surgery | 128 East Apple Street, Wche 7th Floor, Dayton, OH 45409 | 2019-03-16 |
| 1477057529 | Adam Joseph Langer | Student in an Organized Health Care Education/Training Program | 128 E. Apple St Suite 3800, Wright State University Dept of Ob/gyn, Dayton, OH 45409 | 2018-03-22 |
| 1659870939 | Timothy Wall | Student in an Organized Health Care Education/Training Program | 128 East Apple St., 2nd Floor, Dayton, OH 45409 | 2018-02-01 |
| 1124551411 | Adam Schmerge Deardorff | Student in an Organized Health Care Education/Training Program | 30 E Apple St Ste 6257, Dayton, OH 45409 | 2017-04-04 |
| 1205205358 | Kelby Snorf | Physician Assistant | 30 E Apple Street, Suite 3300, Dayton, OH 45409 | 2015-09-18 |
| 1689054223 | Jessica Ezinne Ugwu | Family Medicine | 30 E Apple St., Suite Nw 3300, Dayton, OH 45409 | 2015-06-08 |
| 1679983084 | Jude Anneryan Cohen | Registered Nurse | 1200 W. Dorothy Lane, Southdale Elementary School, Kettering, OH 45409 | 2014-05-07 |
| 1962840884 | Five Rivers Health Centers | Clinic/Center | 30 E Apple St Ste L204, Dayton, OH 45409 | 2013-06-13 |
| Find all providers in zip 45409 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649879248 | Calypso Counseling, LLC | Counselor | 77 W Elmwood Dr Ste 303, Dayton, OH 45459-4270 | 2020-10-23 |
| 1578170403 | Nicholas Daniel Defazio | Counselor | 1951 S Gettysburg Ave, Dayton, OH 45417-4160 | 2020-09-24 |
| 1518576016 | Butler County Community Health Consortium, Inc. | Counselor | 2011 Timber Ln Ste B, Dayton, OH 45414-4528 | 2020-07-30 |
| 1578102075 | Yvonne De La Paix | Counselor | 350 Dayton Valley Rd Apt 15, Dayton, NV 89403-8918 | 2019-12-31 |
| 1346885530 | Arrell Johnson | Counselor | 120 Devonhurst Dr Apt F, Dayton, OH 45429-2180 | 2019-11-12 |
| 1235798968 | Joshua Minnich | Counselor | 1129 Miamisburg Centerville Rd # 201, Dayton, OH 45449-4004 | 2019-06-06 |
| 1669039418 | Lornette Darden Dallas | Counselor | South Community Behavioral Healthcare, 3095 Kettering Blvd, Dayton, OH 45439-2900 | 2019-05-28 |
| 1992268106 | Stephanie Marin Johnson | Counselor | 1611 Railroad St, Dayton, TN 37321-1044 | 2019-04-13 |
| 1447742895 | Darreon Darrell Greer Sr. | Counselor | Counseling and Wellness Services 053 Student Union, Dayton, OH 45435-0001 | 2018-06-01 |
| 1407366511 | Dominique Dixon | Counselor | 1 Elizabeth Pl Ste Rt-1, Dayton, OH 45417-3445 | 2017-10-03 |
| Find all providers in DAYTON | ||||
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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.