JEREMY KEITH CLARK
NPI 1356958383
Marriage & Family Therapist in Ogden, UT

Q: What is Jeremy Clark's NPI number?

The NPI number for Jeremy Clark is 1356958383. It was assigned to this individual provider in the NPPES registry on September 24, 2020.

Q: What is Jeremy Clark's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Q: When was this NPI record last updated?

The NPPES record for Jeremy Clark was last updated on September 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 24, 2020PECOS Enrolled

1525 LINCOLN AVE, OGDEN, UT 84404(801) 621-6510 Get Directions Write a Review

NPPES record last updated: September 24, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Jeremy Keith Clark NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEREMY KEITH CLARK (NPI 1356958383) is an individual marriage & family therapist in Ogden, Utah and active in the NPI registry since September 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1356958383

Entity TypeIndividualMale

Primary Taxonomy106H00000X

Provider Legal NameJEREMY KEITH CLARK

Location Address1525 LINCOLN AVEOgden, UT 84404-5638

Mailing Address566 E 500 NLogan, UT 84321-4251 · (453) 938-8562

Phone(801) 621-6510

Sole ProprietorYes

Medical School CMSOtherGraduated 2021

Enumeration DateSeptember 24, 2020

NPPES CertifiedSeptember 24, 2020

✔ NPI 1356958383 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

Definition

A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

1525 LINCOLN AVE, Ogden, UT 84404

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Utah, Select Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jeremy Keith Clark is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9234634809

PECOS Enrollment IDI20250924004059

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROGER WILLIAM VAN KOMEN LPC

Counselor (Professional)