JAYSON CLARK MSMFT LPC NPI 1598198954

NPI Information

NPI: 1598198954
Provider Name: JAYSON CLARK, MSMFT, LPC
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

PECOS Registration: Yes

Address:
621 W MADRONE ST
ROSEBURG, OR
ZIP 97470
Phone: (541) 672-2691
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Jayson Clark, MSMFT, LPC is a professional counselor in Roseburg, OR with 8 years of experience. Jayson Clark, MSMFT, LPC NPI is 1598198954. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

621 W MADRONE ST
ROSEBURG, OR
ZIP 97470
Phone: (541) 672-2691

The NPI 1598198954 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 8/20/2013 and was last updated on 7/7/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	T-17-081	OREGON	No
2	101YM0800X	Counselor	Mental Health			No
3	101YP2500X	Counselor	Professional	C5596	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500725582	MEDICAID	OREGON
2	500714629	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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