THERESA CLARK
NPI 1457688384
Marriage & Family Therapist in Sebastopol, CA

Q: What is Theresa Clark's NPI number?

The NPI number for Theresa Clark is 1457688384. It was assigned to this individual provider in the NPPES registry on November 13, 2009.

Q: What is Theresa 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 Theresa Clark was last updated on July 8, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since November 13, 2009PECOS Enrolled

1800 GRAVENSTEIN HWY N, SEBASTOPOL, CA 95472(707) 634-9034(707) 823-3410 Get Directions Write a Review

NPPES record last updated: July 8, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Theresa Clark NPPES

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

THERESA CLARK (NPI 1457688384) is an individual marriage & family therapist in Sebastopol, California, licensed in California (47533) and active in the NPI registry since November 2009. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457688384

Entity TypeIndividualFemale

Primary Taxonomy106H00000X

Provider Legal NameTHERESA CLARK

Location Address1800 GRAVENSTEIN HWY NSebastopol, CA 95472-2607

Mailing Address1800 Gravenstein Hwy NSebastopol, CA 95472-2607 · (707) 634-9063 · Fax (707) 823-3410

Phone(707) 634-9034

Fax(707) 823-3410

Sole ProprietorYes

Enumeration DateNovember 13, 2009

Last NPPES UpdateJuly 8, 2016

✔ NPI 1457688384 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

License✔ Licensed in CA · 47533

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.

1800 GRAVENSTEIN HWY N, Sebastopol, CA 95472

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Theresa Clark 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.