MRS. NICOLE LANE CLARK LCSW
NPI 1467893032
Counselor - Mental Health in Shingletown, CA

Q: What is Nicole Clark's NPI number?

The NPI number for Nicole Clark is 1467893032. It was assigned to this individual provider in the NPPES registry on July 11, 2013.

Q: What is Nicole Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Nicole Clark was last updated on May 21, 2021. 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 July 11, 2013PECOS EnrolledAccepts Medicare Assignment

31292 ALPINE MEADOWS RD, SHINGLETOWN, CA 96088(530) 474-3390(530) 474-1407 Get Directions Write a Review

NPPES record last updated: May 21, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Mrs. Nicole Lane Clark Lcsw NPPES

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

MRS. NICOLE LANE CLARK LCSW (NPI 1467893032) is an individual mental health provider in Shingletown, California, licensed in California (91794) and active in the NPI registry since July 2013. She is enrolled in Medicare PECOS, maintains a secondary practice location in Lancaster, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1467893032

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameMRS. NICOLE LANE CLARKCredential: LCSW

Location Address31292 ALPINE MEADOWS RDShingletown, CA 96088-9462

Mailing Address1005 Magnolia AveRedding, CA 96001-0314 · (530) 209-5545

Phone(530) 474-3390

Fax(530) 474-1407

Sole ProprietorYes

Medical School CMSOtherGraduated 2013

Enumeration DateJuly 11, 2013

Last NPPES UpdateMay 21, 2021

NPPES CertifiedMay 21, 2021

✔ NPI 1467893032 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in CA · 91794

31292 ALPINE MEADOWS RD, Shingletown, CA 96088

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Secondary Practice Location 1

Location 143423 Division StLancaster, CA 93535-4639 · Phone (661) 266-4783 · Fax (661) 266-1210

Other Identifiers 1

Other95-2633765CA · Medi-cal

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Nicole Lane Clark Lcsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6305364555

PECOS Enrollment IDI20250520004690

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 11

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

DR. ALBERT GORDON LUI MD

Family Medicine