KEITH R CLARK (NPI# 1902201809) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902201809 |
| Entity Type | Individual |
| Full Name | KEITH R CLARK |
| Credential | LPCC |
| Practice Address |
601 South Edwin C Moses Blvd Dayton OH 45417-3424 |
| Practice Telephone | 9377348333 |
| Practice Fax Number | 9372768269 |
| Mailing Telephone | 9377348333 |
| Mailing Fax Number | 9372768269 |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2019-12-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
C1300707TRNE | OH | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
E.1901518 | OH | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346739737 | Keith Wayne Clark | Physical Therapy Assistant | 406 S Main St, Winnsboro, TX 75494-3226 | 2018-05-01 |
| 1114453933 | Keith Anthony Clark | Massage Therapist | 11311 N Central Expy, Ste 211, Dallas, TX 75243-6707 | 2017-05-11 |
| 1376811018 | Keith Lyle Clark | Counselor | 1500 Franklin St, San Francisco, CA 94109-4523 | 2011-12-08 |
| 1730262684 | Keith Lee Clark | Dentist | 1116 N Meadows Dr, Granbury, TX 76048-1717 | 2006-10-23 |
| 1437167616 | Keith Terrill Clark | Emergency Medicine | 400 Broadway St, Cincinnati, OH 45202-3312 | 2006-08-04 |
| 1376506642 | Keith Fredrick Clark | Otolaryngology | 535 Nw 9th St, Suite 300, Oklahoma City, OK 73102-1070 | 2006-04-08 |
| Street Address |
601 SOUTH EDWIN C MOSES BLVD |
| City | DAYTON |
| State | OH |
| Zip Code | 45417-3424 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316919137 | Amy B Jones | Social Worker | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2006-02-06 |
| 1942809660 | Michelle Toops | Registered Nurse | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2020-10-23 |
| 1912505579 | Anna B Chambers | Registered Nurse | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2020-10-15 |
| 1639776057 | Johnna G Kovach | Social Worker | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2020-10-08 |
| 1083229751 | Jenna J Branam | Registered Nurse | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2020-09-10 |
| 1982219549 | Sarah A Long | Case Manager/Care Coordinator | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2020-09-10 |
| 1447863550 | Jennifer Marshall | Registered Nurse | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2020-08-28 |
| 1174136436 | Ericka Hughes | Social Worker | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2020-08-26 |
| 1437760592 | Megan Schrodi | Social Worker | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2020-08-12 |
| 1174132922 | Emily M Hunter | Registered Nurse | 601 South Edwin C Moses Blvd, Dayton, OH 45417-3424 | 2020-07-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891329504 | Kanika Crowder | Home Health Aide | 5964 Hoover Ave, Dayton, OH 45417 | 2020-03-03 |
| 1427510510 | Michael S Hatesohl | Student in an Organized Health Care Education/Training Program | 627 South Edwin C. Moses Blvd., East Medical Plaza, 1st Floor, Dayton, OH 45417 | 2019-04-05 |
| 1205313350 | Latonda T Brewer | Home Health Aide | 3900 Cone Ct, Dayton, OH 45417 | 2018-07-22 |
| 1205326048 | Diane Fillmore | Case Manager/Care Coordinator | 1818 West Main Street, Dayton, OH 45417 | 2018-05-17 |
| 1295222941 | Zainab Saherwala | Student in an Organized Health Care Education/Training Program | 627 S. Edwin C. Moses, East Medical Plaza, 1st Floor, Dayton, OH 45417 | 2018-04-18 |
| 1013430123 | Bridgette Elizabeth Quinlin | Counselor | 4104 Germantown St, Dayton, OH 45417 | 2017-07-20 |
| 1083144679 | Tadesha Marie Gay | Licensed Practical Nurse | 4748 Ericson Ave, Dayton, OH 45417 | 2017-06-15 |
| 1386180099 | Bio-medical Applications of Ohio, Inc. | Clinic/Center | 821 S Edwin C Moses Blvd, Dayton, OH 45417 | 2017-01-19 |
| 1770039760 | Jamie E Denlinger | Social Worker | 1 Elizabeth Pl Fl 3, Dayton, OH 45417 | 2016-08-30 |
| 1780069823 | Care4us Behavioral Health Center, LLC | Community/Behavioral Health | 1 Elizabeth Place, Ste 1170, Dayton, OH 45417 | 2015-07-29 |
| Find all providers in zip 45417 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891302188 | Five Rivers Health Centers | Counselor | 120 W Apple St Ste 100, Dayton, OH 45402-2617 | 2020-09-30 |
| 1316571748 | Kristy Sue Dillon | Counselor | 8801 N Main St, Dayton, OH 45415-1385 | 2020-02-25 |
| 1952892135 | New Hope New Liberty Counseling, Pllc | Counselor | 410 E Waring St, Dayton, TX 77535-1833 | 2018-05-23 |
| 1427588060 | Daniel Wick | Counselor | 1 Elizabeth Pl Ste 190, Dayton, OH 45417-3445 | 2017-06-15 |
| 1003341744 | Chuckeia Folley | Counselor | 508 Heather Dr Apt 3, 3, Dayton, OH 45405-1731 | 2017-05-01 |
| 1205374055 | Melissa Deaton Cook | Counselor | Suite D 206 Main Street, Dayton, VA 22821-0910 | 2017-02-01 |
| 1851837041 | Jessica White | Counselor | 727 Grafton Ave, Dayton, OH 45406-5256 | 2017-01-11 |
| 1093186561 | Scott Campbell | Counselor | 11 W Monument Ave, Ste 310, Dayton, OH 45402-1274 | 2015-10-09 |
| 1770959751 | Debbie Lyn Gunnels | Counselor | 327 Misty Oaks Ct, Dayton, OH 45415-1370 | 2015-08-13 |
| 1750775110 | Nicole C Duff | Counselor | Six Patterson Blvd, Sbhi- Cam, Dayton, OH 45402 | 2015-03-24 |
| 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.