DR. BRIAN CLARK (NPI# 1629129804) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629129804 |
| Entity Type | Individual |
| Full Name | DR. BRIAN CLARK |
| Credential | PSY.D. |
| Practice Address |
954 Risa Rd Suite A Lafayette CA 94549-3418 |
| Mailing Address |
Po Box 290 Orinda CA 94563-0290 |
| Practice Telephone | 9253858050 |
| Mailing Telephone | 9253858050 |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2013-03-30 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
PSY25198 | CA | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PSY25198 | CA | Behavioral Health & Social Service Providers |
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
PSY25198 | CA | Behavioral Health & Social Service Providers |
| N | 103TF0000X |
Psychologist Specialization: Family |
PSY25198 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992363345 | Brian K Clark Sr. | Licensed Practical Nurse | 15201 Judson Dr, Cleveland, OH 44128-1956 | 2019-05-31 |
| 1073046421 | Brian Clark | Chiropractor | 140 Hidden Lake Ln, Peninsula, OH 44264-9578 | 2017-04-04 |
| 1538618277 | Brian Clark | Specialist/Technologist | 9950 Bruceville Rd Apt 147, Elk Grove, CA 95757-9511 | 2016-09-22 |
| 1942758222 | Brian Christopher Clark | Counselor | 2631 Bulverde Rd, Suite 108, Bulverde, TX 78163-2107 | 2016-09-15 |
| 1740653518 | Brian Clark | Pharmacist | 8312 Serenity Way, Denton, TX 76210-0823 | 2015-11-03 |
| 1437548062 | Brian Clark | Occupational Therapist | 4718 Tenbury Ln, Rocklin, CA 95677-4487 | 2015-01-20 |
| 1144524851 | Brian Allan Clark | Respiratory Therapist, Certified | 2910 N Saginaw Rd, Midland, MI 48640-2634 | 2011-01-10 |
| 1679801286 | Brian Keith Clark | Physical Therapy Assistant | 1407 Melbourne St, Foster City, CA 94404-3960 | 2009-11-20 |
| 1497907190 | Brian R. Clark | Counselor | 623 W Easterday Ave, Sault Sainte Marie, MI 49783-1625 | 2008-10-14 |
| 1083756274 | Brian Edward Clark | Dentist | 5544 Turney Rd, Garfield Hts, OH 44125-3780 | 2007-02-13 |
| Street Address |
954 RISA RD SUITE A |
| City | LAFAYETTE |
| State | CA |
| Zip Code | 94549-3418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457383556 | Austin Gollmer Hurst | Psychologist | 954 Risa Rd, Suite A, Lafayette, CA 94549-3418 | 2006-07-07 |
| 1003354374 | Leslie Foge | Marriage & Family Therapist | 954 Risa Rd, Suite A, Lafayette, CA 94549-3418 | 2017-02-07 |
| 1811002819 | Susan Marie Jenny | Psychologist | 954 Risa Rd, Suite A, Lafayette, CA 94549-3418 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104427004 | Veronica Adelaid Valera-averilla | Behavior Technician | 3650 Mt Diablo Blvd. Ste. 107, Lafayette Ca Contra, CA 94549 | 2020-11-06 |
| 1679128870 | Zong Ning Zhou | Behavior Technician | 3650 Mt.diablo Blvd., Suite 107, Lafayette, CA 94549 | 2019-08-05 |
| 1912551227 | Tamiesha Jackson | Behavior Technician | Ste Consultant, LLC, 3650 Mt. Diablo Blvd, Suite 107, Lafayette, CA 94549 | 2019-07-25 |
| 1528525375 | Tiara Lajai Aubrey | Behavior Technician | 3560 Mt. Diablo Blvd, Suite 107, Layfatte, CA 94549 | 2019-02-28 |
| 1215409990 | Marisa Della Marmolejo | Case Manager/Care Coordinator | Ste Consultants, LLC 3650 Mt Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-12-19 |
| 1235608399 | Andrew Thompson | Behavior Technician | 3650 Mt. Diablo Blvd, Suite 107, Lafayette, CA 94549 | 2018-11-19 |
| 1982172953 | Amber Jackson | Behavior Technician | Ste, LLC, 3650 Mt. Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-11-08 |
| 1104393396 | Alexis Taper | Behavior Technician | Ste Consultants LLC, 3650 Mt. Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-10-26 |
| 1023508793 | Alyssa Savinovich | Behavior Technician | 3560 Mt. Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-05-17 |
| 1831689140 | Kannambra M Raja | Behavior Technician | Ste Consultants LLC, 3650 Mt. Diablo Blvd, Suite 107, Lafayette, CA 94549 | 2018-05-11 |
| Find all providers in zip 94549 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336621291 | Wesley Ward Ph.d LLC | Psychologist | 100 Saw Mill Rd Ste 3104, Lafayette, IN 47905-5598 | 2018-09-06 |
| 1396238275 | Lafayette Psychology Center, LLC | Psychologist | 905 Jefferson St Ste 410, Lafayette, LA 70501-7900 | 2018-06-14 |
| 1023468154 | Marilyn Steele | Psychologist | 965 Moraga Rd, Lafayette, CA 94549-4422 | 2016-06-20 |
| 1396012183 | Jesus Sanchez | Psychologist | 150 Old Laramie Trl Unit 120, Lafayette, CO 80026 | 2011-11-21 |
| 1992025720 | Amy E Cavanaugh Phd LLC | Psychologist | 4540 Ambassador Caffery Pkwy Ste C200, Lafayette, LA 70508-6930 | 2010-06-03 |
| 1972734242 | Bianchini-strother/boudreaux, LLC | Psychologist | 107 Regency Sq, Lafayette, LA 70508-4221 | 2009-08-04 |
| 1649423195 | Andrew Michaels | Psychologist | 3184 Old Tunnel Rd Ste A, Lafayette, CA 94549-4153 | 2008-10-28 |
| 1306023130 | Sonja Hellman | Psychologist | 1373 Forest Park Cir Ste 204, Lafayette, CO 80026-3193 | 2008-01-23 |
| 1174744239 | Suzanne Moselle Allen | Psychologist | 3249 Mt. Diablo Blvd., Suite 210, Lafayette, CA 94549 | 2007-05-02 |
| 1336360734 | Dai To | Psychologist | 3468 Mt Diablo Blvd Ste 201, Lafayette, CA 94549-3957 | 2007-05-01 |
| Find all providers in LAFAYETTE | ||||
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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.