MARK CLARK SUDC NPI 1720119167

NPI Information

NPI: 1720119167
Provider Name: MARK CLARK, SUDC
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1366 W INDIAN HILLS DR UNIT 69
SAINT GEORGE, UT
ZIP 84770
Phone: (406) 293-7731
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Mark Clark, SUDC is an addiction (substance use disorder) counselor in Saint George, UT. Mark Clark, SUDC NPI is 1720119167. 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:

1366 W INDIAN HILLS DR UNIT 69
SAINT GEORGE, UT
ZIP 84770-885
Phone: (406) 293-7731
Fax: (406) 297-2823

The enumeration date for this NPI number is 3/8/2007 and was last updated on 9/20/2018.

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)	22	MONTANA	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	0320372	MEDICAID	MONTANA
2	760460	OTHER	MONTANA	CHIP
3	0000073691	OTHER	MONTANA	BLUE CROSS BLUE SHIELD

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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