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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JERRY DEAN CLARK SUDP, CPSS
NPI 1497232060
Counselor - Addiction (Substance Use Disorder) in Centralia, WA

Active since July 25, 2018
1126 S GOLD ST, CENTRALIA, WA 98531(360) 827-4929(844) 612-6673 Get Directions Write a Review

NPPES record last updated: August 31, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Aug 31, 2026, Nov 13, 2020, Oct 30, 2020 and 3 more (6 updates tracked since 2018).

About Jerry Dean Clark Sudp, Cpss NPPES

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

JERRY DEAN CLARK SUDP, CPSS (NPI 1497232060) is an individual addiction (substance use disorder) provider in Centralia, Washington, licensed in Washington (CP61099597) and active in the NPI registry since July 2018.

NPPES Registry Identity

NPI1497232060
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameJERRY DEAN CLARKCredential: SUDP, CPSS
Location Address1126 S GOLD STCentralia, WA 98531-3714
Mailing AddressPo Box 2394Longview, WA 98632-8455 · (360) 200-5419 · Fax (360) 200-6736
Phone(360) 827-4929
Fax(844) 612-6673
Sole ProprietorNo
Enumeration DateJuly 25, 2018
Last NPPES UpdateAugust 31, 20266 updates tracked since enumeration
NPPES CertifiedAugust 31, 2026
✔ NPI 1497232060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in WA · CP61099597
Also ListedPeer SpecialistTaxonomy 175T00000X · License PR70101410 (WA)
1126 S GOLD ST, Centralia, WA 98531
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Other Identifiers 1

Medicaid2140419WA

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.

BRYAN STURGILL AAC, CPC
Peer Specialist
1126 S GOLD ST
CENTRALIA, WA 98531
Lewis County (360) 807-4929
CARLY HOLMES AAC, CPC
Peer Specialist
1126 S GOLD ST
CENTRALIA, WA 98531
Lewis County (360) 807-4929
MRS. TAYLOR MARLANE MCLYNNE BS, R-AAC
Counselor
1126 S GOLD ST
CENTRALIA, WA 98531
Lewis County (360) 807-4929
JOHN D LOPEZ II AAC
Counselor
1126 S GOLD ST
CENTRALIA, WA 98531
Lewis County (360) 807-4929
ELIZABETH MULLINS CPC
Peer Specialist
1126 S GOLD ST
CENTRALIA, WA 98531
Lewis County (360) 807-4929
HILARY MARTINEZ JR. BS, AAC
Counselor
1126 S GOLD ST
CENTRALIA, WA 98531
Lewis County (360) 807-4929
AMANDA MARIE CASHION BSW, R-AAC
Counselor
1126 S GOLD ST
CENTRALIA, WA 98531
Lewis County (360) 807-4929
AMANDA MULLINS AA, R-AAC, CPC
Peer Specialist
1126 S GOLD ST
CENTRALIA, WA 98531
Lewis County (360) 807-4929

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 Jerry Clark's NPI number?

The NPI number for Jerry Clark is 1497232060. It was assigned to this individual provider in the NPPES registry on July 25, 2018.

Where is Jerry Clark located?

Jerry Clark practices at 1126 S Gold St, Centralia, WA 98531. The listed phone number is (360) 827-4929.

What is Jerry Clark's specialty?

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

When was this NPI record last updated?

The NPPES record for Jerry Clark was last updated on August 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 days 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.