MR. MITCHELL BRADY CLARK (NPI# 1578798278) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578798278 |
| Entity Type | Individual |
| Full Name | MR. MITCHELL BRADY CLARK |
| Credential | M.S. |
| Practice Address |
6160 Mission Gorge Rd Ste 120 San Diego CA 92120-3425 |
| Practice Telephone | 6192822232 |
| Practice Fax Number | 6192822992 |
| Mailing Telephone | 6192822232 |
| Mailing Fax Number | 6192822992 |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2010-07-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
RC00050738 | WA | Behavioral Health & Social Service Providers |
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205307204 | Mitchell Clark | Counselor | 890 Hayes St, San Francisco, CA 94117-2615 | 2018-12-17 |
| 1669817854 | Mitchell Brent Clark | Obstetrics & Gynecology | 333 Cedar St., Yale Medical School, New Haven, CT 06510 | 2013-05-02 |
| Street Address |
6160 MISSION GORGE RD STE 120 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92120-3425 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548596018 | Amanda Beth Cohen | Counselor | 6160 Mission Gorge Rd Ste 120, San Diego, CA 92120-3425 | 2009-10-19 |
| 1124351259 | Midori Saito | Counselor | 6160 Mission Gorge Rd Ste 120, San Diego, CA 92120-3425 | 2009-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316550510 | Jessica Elizabeth Knight | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Ct, 310, San Diego, CA 92120 | 2020-08-26 |
| 1770195091 | Julia Roccanova | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Court, Suite 310, San Diego, CA 92120 | 2020-08-18 |
| 1225593601 | Truself Training, Inc | Clinic/Center | 5125 Waring Road, San Diego, CA 92120 | 2019-02-09 |
| 1508381799 | Antin Sachs | In Home Supportive Care | 4420 Rainier Avenue, Suite 202, San Diego, CA 92120 | 2017-08-08 |
| 1588186415 | Matthew B Wilbat | Behavioral Analyst | 6851 Alvarado Rd., #17, San Diego, CA 92120 | 2017-07-12 |
| 1548782923 | Mori Khatibzadeh Dds Inc. | Clinic/Center | 6171 Mission Gorge Road, Suite #114, San Diego, CA 92120 | 2017-07-07 |
| 1306379359 | Ken Samith Oerding | Nurse Practitioner | 5422 Reservoir Drive, E7, San Diego Ca, CA 92120 | 2017-04-06 |
| 1396134409 | Debra Michele Stern-ellis | Social Worker | 4647 Zion Avenue Kaiser Permanente, 2nd Floor - Oncology, San Diego, CA 92120 | 2015-01-13 |
| 1821494717 | Shohreh Tourian | Dentist | 7451 Mission Gorge Road, San Diego, CA 92120 | 2014-11-05 |
| 1184049215 | Charles Yin | Counselor | 6153 Fairmount Ave Suite #260, San Diego, CA 92120 | 2014-02-26 |
| Find all providers in zip 92120 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457963738 | Diyana Giorgees | Case Manager/Care Coordinator | 5005 Texas Street, St. 203, San Diego, CA 92108 | 2020-08-19 |
| 1770105439 | Timothy Mccloud | Case Manager/Care Coordinator | 6160 Mission Gorge Rd # 108, San Diego, CA 92120-3410 | 2020-05-15 |
| 1043846272 | Daniel Rafael Martinez | Case Manager/Care Coordinator | 8825 Aero Dr Ste 305, San Diego, CA 92123-2270 | 2020-03-19 |
| 1043844376 | Ariel A Anderson | Case Manager/Care Coordinator | 8501 Larkdale Ave, San Diego, CA 92123-2047 | 2020-02-25 |
| 1124664818 | Sarah Milan | Case Manager/Care Coordinator | 1846 30th St Apt A, San Diego, CA 92102-1145 | 2019-11-18 |
| 1750930814 | Christine Guianne Mupas Ramos | Case Manager/Care Coordinator | 1660 Hotel Cir N # 320, San Diego, CA 92108-2807 | 2019-09-10 |
| 1437708518 | Brendan Domingo Guerra | Case Manager/Care Coordinator | 5617 Vista San Juanico, San Diego, CA 92154-5672 | 2019-09-10 |
| 1457912982 | Kendra Crater | Case Manager/Care Coordinator | 3481 Kurtz St, San Diego, CA 92110-4430 | 2019-06-25 |
| 1790342319 | Ariella Beth Darlington | Case Manager/Care Coordinator | 3644 Princeton Ave, San Diego, CA 92117-5637 | 2019-05-20 |
| 1013572361 | Brandon Joel Jessie | Case Manager/Care Coordinator | 1250 Morena Blvd Bldg 2nd, San Diego, CA 92110-3815 | 2019-05-02 |
| Find all providers in SAN DIEGO | ||||
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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.