KELLY CLARK BS CADC I NPI 1861796641

NPI Information

NPI: 1861796641
Provider Name: KELLY CLARK, BS, CADC I
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
400 NE 7TH ST
GRESHAM, OR
ZIP 97030
Phone: (503) 661-5455
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Kelly Clark, BS, CADC I is an addiction (substance use disorder) counselor in Gresham, OR. Kelly Clark, BS, CADC I NPI is 1861796641. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

400 NE 7TH ST
GRESHAM, OR
ZIP 97030-604
Phone: (503) 661-5455
Fax: (503) 661-4959

The enumeration date for this NPI number is 1/7/2011 and was last updated on 1/7/2011.

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)			Yes

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: 11/14/2023

NPI Synchronization or Removal

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