NICKLAUS CLARK LPC, LMHC
NPI 1407251408
Counselor - Professional in Gresham, OR

Active since November 03, 2014PECOS Enrolled
1700 NW CIVIC DR, SUITE 310, GRESHAM, OR 97030(503) 233-5405 Get Directions Write a Review

NPPES record last updated: February 4, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Nicklaus Clark Lpc, Lmhc NPPES

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

NICKLAUS CLARK LPC, LMHC (NPI 1407251408) is an individual professional provider in Gresham, Oregon, licensed in Oregon (C3550) and active in the NPI registry since November 2014. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1407251408
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameNICKLAUS CLARKCredential: LPC, LMHC
Location Address1700 NW CIVIC DR, SUITE 310Gresham, OR 97030-3770
Mailing AddressPo Box 82819Portland, OR 97282-0819 · (503) 233-5405
Sole ProprietorNo
Enumeration DateNovember 3, 2014
Last NPPES UpdateFebruary 4, 2016
NPI 1407251408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
Licenses Licensed in OR · C3550 Licensed in MO · 2012024654
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License LH60497951 (WA)
1700 NW CIVIC DR, Gresham, OR 97030

Accepted 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)

Nicklaus Clark Lpc, Lmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 12

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

Counselor (Professional)
1700 NW CIVIC DR
GRESHAM, OR 97030
Psychologist
1700 NW CIVIC DR
GRESHAM, OR 97030
Counselor (Mental Health)
1700 NW CIVIC DR, SUITE 310
GRESHAM, OR 97030
Counselor (Professional)
1700 NW CIVIC DR, SUITE 310
GRESHAM, OR 97030
Marriage & Family Therapist
1700 NW CIVIC DR, SUITE 310
GRESHAM, OR 97030
Behavior Analyst
1700 NW CIVIC DR, 310
GRESHAM, OR 97030
Counselor (Mental Health)
1700 NW CIVIC DR, SUTIE 310
GRESHAM, OR 97030
Counselor (Mental Health)
1700 NW CIVIC DR, SUITE 310
GRESHAM, OR 97030

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicklaus Clark's NPI number?

The NPI number for Nicklaus Clark is 1407251408. It was assigned to this individual provider in the NPPES registry on November 3, 2014.

Where is Nicklaus Clark located?

Nicklaus Clark practices at 1700 NW Civic Dr Suite 310, Gresham, OR 97030. The listed phone number is (503) 233-5405.

What is Nicklaus Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Nicklaus Clark enrolled in Medicare?

Yes. Nicklaus Clark is registered in the Medicare PECOS enrollment system.

What insurance does Nicklaus Clark accept?

Health plans from BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc., PacificSource Health Plans and Providence Health Plan and 1 other insurer list Nicklaus Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Nicklaus Clark was last updated on February 4, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.