MR. GREGORY D CLARK


Address: 118 Broadway N, Ste 810, Fargo, ND 58102-4949
Phone: 7017998785

MR. GREGORY D CLARK (NPI# 1689608952) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1689608952
Entity Type Individual
Full Name MR. GREGORY D CLARK
Credential MSW
Practice Address 118 Broadway N
Ste 810
Fargo
ND 58102-4949
Practice Telephone 7017998785
Practice Fax Number 7012054930
Mailing Telephone 7017998785
Mailing Fax Number 7012054930
Enumeration Date 2006-07-10
Last Update Date 2016-03-25
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1041C0700X Social Worker
Specialization: Clinical
LICSW 2973 ND Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
MN BCBS OF MN PIN 03Q32CL 01
ND BCBS OF ND PIN 015066 01

Other Providers GREGORY CLARK

NPI Name Taxonomy Address Enumeration
1760991012 Gregory Clark Driver 1091 Old South Dr, Lakeland, FL 33811 2017-09-28
1184758229 Gregory Ray Clark Physical Therapist 3 Windsor Ct, Shawnee, OK 74804-2330 2007-03-14
1114064797 Gregory Dale Clark Dentist 4212 Mcever Rd, Oakwood, GA 30566-2237 2007-01-31
1225141823 Gregory Lynn Clark Specialist 11790 Sw Barnes Rd, Suite 330, Portland, OR 97225-5934 2006-08-16
1164409728 Gregory Clark Counselor 225 N Beaumont Rd, Prairie Du Chien, WI 53821-1445 2005-12-26
1528627833 Gregory Scott Clark Nurse Anesthetist, Certified Registered 3333 W Deyoung St, Marion, IL 62959-5884 2019-06-10
1073178851 Gregory Clark Student in an Organized Health Care Education/Training Program 550 1st Ave, New York, NY 10016-6402 2019-05-07
1548736622 Gregory Allen Clark Marriage & Family Therapist 1150 5th St Ste 270, Coralville, IA 52241-2933 2018-10-16
1881055911 Gregory Scott Clark Jr. Counselor 1121 E Southeast Loop 323 Ste 204, Tyler, TX 75701 2016-03-17
1164841102 Gregory S Clark Physician Assistant 8433 Harcourt Rd Ste 100, Indianapolis, IN 46260-2193 2014-04-07

Office Location

Street Address 118 BROADWAY N
STE 810
City FARGO
State ND
Zip Code 58102-4949

Providers in the same location

NPI Name Taxonomy Address Enumeration
1144600800 Gregory D. Clark, Msw, LLC Social Worker 118 Broadway N, Suite 810, Fargo, ND 58102-4949 2015-06-08
1356606974 Midwest Eye Laboratories Sioux Falls, LLC Prosthetic/Orthotic Supplier 118 Broadway N, Ste 605, Fargo, ND 58102-4950 2012-07-10
1134445794 Midwest Hypnosis Clinics/nwcc Clinic/Center 118 Broadway N, Suite 205, Fargo, ND 58102-4950 2010-04-07
1356570733 United States Medical Supply, Inc. Durable Medical Equipment & Medical Supplies 118 Broadway N, Suite 414, Fargo, ND 58102-4950 2009-07-07
1649422395 Steven F. Hundley Counselor 118 Broadway N, Suite 416, Fargo, ND 58102-4950 2008-10-14

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1780285924 Shelley Dene Townsend-hansen Dentist 1017 Broadway N, Fargo, ND 58102 2020-11-04
1275190779 Anthony Joseph Duncan Student in an Organized Health Care Education/Training Program 1919 Elm Streent North, Fargo, ND 58102 2019-05-21
1003472317 Sadie Marie Nelson Nurse Practitioner Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 2019-05-13
1124523576 Christopher Peroutka Specialist/Technologist 1300 17th Ave N, Fargo, ND 58102 2018-03-28
1205331873 Nathan Koens Specialist/Technologist 1300 17th Avenue North, Fargo, ND 58102 2018-03-27
1376063370 Abby Nicole Fredrickson Student in an Organized Health Care Education/Training Program 1919 Elm Street North, Fargo, ND 58102 2017-06-21
1780118331 Stephanie Melquist Internal Medicine Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 2017-04-19
1104215623 Justin Lervik Social Worker 211 Elm St. N, 122, Fargo, ND 58102 2015-01-21
1770919441 Courtney Ann Simanski Speech-Language Pathologist 415 4th St. N., Fargo, ND 58102 2013-09-25
1821431206 Lanell Staroba Pharmacist 706 D 38th St, Fargo, ND 58102 2013-04-16
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Taxonomy Information

Taxonomy Code 1041C0700X
Grouping Behavioral Health & Social Service Providers
Classification Social Worker
Specialization Clinical

Taxonomy Definition

A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1861955296 Empower Counseling LLC Social Worker 4675 40th Ave S Ste 130, Fargo, ND 58104-4444 2019-04-11
1295262897 Centerstone Counseling Social Worker 417 38th St Sw Ste D, Fargo, ND 58103-6508 2017-05-15
1992252621 Brittany Schank Social Worker 1321 23rd St S Ste D, Fargo, ND 58103-3724 2016-09-11
1558726083 Cathy Lynn Bauer-kottenbrock Social Worker 2101 Elm Street N, Fargo, ND 58102-2498 2015-12-29
1104215623 Justin Lervik Social Worker 211 Elm St. N, 122, Fargo, ND 58102 2015-01-21
1942625983 Jennifer Lenore Anderson Social Worker 1351 Page Dr S Ste 202, Fargo, ND 58103-3536 2014-02-27
1992147243 Shawna Marie Croaker Social Worker 4553 9th Ave S Ste 3, Fargo, ND 58103-7253 2013-07-26
1992056147 Nicholas Gard Social Worker 1112 Nodak Dr S Ste 105, Fargo, ND 58103-2366 2012-09-27
1265707848 Erika Louise Lake Social Worker 1330 Page Dr S Ste 101, Fargo, ND 58103-3551 2012-03-15
1346519378 Trishia K Powell Social Worker 3125 41st St S, Fargo, ND 58104-8666 2011-12-20
Find all providers in FARGO

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City FARGO
Zip Code 58102

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Dataset Information

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.

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