1. Home
  2. Directory
  3. Ohio
  4. Lorain
  5. Counselor
  6. NPI Profile

LEESA G CLARK LICDC
NPI 1447610910
Counselor - Addiction (Substance Use Disorder) in Lorain, OH

Active since February 26, 2016PECOS Enrolled
2115 W PARK DR, LORAIN, OH 44053(440) 989-4987(440) 282-4779 Get Directions Write a Review

NPPES record last updated: July 7, 2016. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Leesa G Clark Licdc NPPES

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

LEESA G CLARK LICDC (NPI 1447610910) is an individual addiction (substance use disorder) provider in Lorain, Ohio, licensed in Ohio (ICDC.081105) and active in the NPI registry since February 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2011).

NPPES Registry Identity

NPI1447610910
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameLEESA G CLARKCredential: LICDC
Location Address2115 W PARK DRLorain, OH 44053-1138
Mailing Address2115 W Park DrLorain, OH 44053-1138 · (440) 989-4987 · Fax (440) 282-4779
Phone(440) 989-4987
Fax(440) 282-4779
Sole ProprietorYes
Medical School CMSOtherGraduated 2011
Enumeration DateFebruary 26, 2016
Last NPPES UpdateJuly 7, 2016
✔ NPI 1447610910 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in OH · ICDC.081105
2115 W PARK DR, Lorain, OH 44053
Open in Google Maps ↗

Other Identifiers 1

OtherICDC.081105OH · License Number

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource, Oscar Health Insurance, Oscar Insurance Corporation of Ohio.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Leesa G Clark Licdc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6002384088
PECOS Enrollment IDI20260507003004
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.

Medicare Billing Reassignment

Medicare enrollment records show Leesa Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Riveon Mental Health And Recovery
3.5 mi
Primary Care
6140 S BROADWAY
Lorain, OH 44053
  • Reassigned Medicare billing, Ohio enrollment
  • 70 clinicians in this Medicare group
NPI 1376234914 (440) 233-7232

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 20

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

EMILY WINFIELD OCPSA.161655
Prevention Professional
2115 W PARK DR
LORAIN, OH 44053
Lorain County (440) 989-4900
RACHEL RUPERT LPN
Licensed Practical Nurse
2115 W PARK DR
LORAIN, OH 44053
Lorain County (440) 989-4900
KENNEDY FAITH WILBERT CYPS, OCPSA
Prevention Professional
2115 W PARK DR
LORAIN, OH 44053
Lorain County (440) 989-4900
REBECCA A MANGOL RN
Registered Nurse (Addiction (Substance Use Disorder))
2115 W PARK DR
LORAIN, OH 44053
Lorain County (440) 989-4900
LAURIE JONES CDCA
Counselor (Addiction (Substance Use Disorder))
2115 W PARK DR
LORAIN, OH 44053
Lorain County (440) 989-4905
LORAIN COUNTY ALCOHOL & DRUG ABUSE SERVICES, INC.
Community/Behavioral Health
2115 W PARK DR
LORAIN, OH 44053
Lorain County (440) 282-4777
PAULA LYN MINCH RN
Registered Nurse
2115 W PARK DR
LORAIN, OH 44053
Lorain County (440) 989-4900
DEREK BENTOFF CDCA
Counselor (Addiction (Substance Use Disorder))
2115 W PARK DR
LORAIN, OH 44053
Lorain County (440) 989-4900

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 Leesa Clark's NPI number?

The NPI number for Leesa Clark is 1447610910. It was assigned to this individual provider in the NPPES registry on February 26, 2016.

Where is Leesa Clark located?

Leesa Clark practices at 2115 W Park Dr, Lorain, OH 44053. The listed phone number is (440) 989-4987.

What is Leesa Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Leesa Clark enrolled in Medicare?

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

Which organization bills Medicare for Leesa Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Leesa Clark reassigns Medicare benefits to Riveon Mental Health And Recovery (Lorain, OH). 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 Leesa Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Leesa Clark accept?

Health plans from CareSource, Oscar Health Insurance and Oscar Insurance Corporation of Ohio list Leesa 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 Leesa Clark was last updated on July 7, 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.