NICKLAUS CLARK LPC, LMHC
NPI 1407251408
Counselor - Professional in Gresham, OR
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
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Nicklaus Clark Lpc, Lmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Nicklaus Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Beaverton, OR 97005
- Reassigned Medicare billing, Oregon enrollment
- 46 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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.
Which organization bills Medicare for Nicklaus Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Nicklaus Clark reassigns Medicare benefits to Brightspire Health, LLC (Beaverton, OR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicklaus Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
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.
# Nicklaus Clark, LPC, LMHC · NPI 1407251408
Professional provider in Gresham, Oregon. Individual provider, active in the CMS NPPES registry since November 3, 2014.
## Identity
- **NPI:** 1407251408 (Entity type: Individual)
- **Enumerated:** November 3, 2014
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** C3550 (Oregon)
- **Sole proprietor:** No
## Practice location
- **Address:** 1700 NW CIVIC DR, SUITE 310, Gresham, OR 97030-3770
- **Phone:** (503) 233-5405
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Brightspire Health, LLC (NPI 1518656776, Beaverton, OR), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 4, 2016
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Source: [NPI Profile](https://npiprofile.com/npi/1407251408) · Data from the CMS NPPES public registry.