CAMILLIA CLARK COUI-9541
NPI 1528840584
Counselor - Mental Health in Idaho Falls, ID

Q: What is Camillia Clark's NPI number?

The NPI number for Camillia Clark is 1528840584. It was assigned to this individual provider in the NPPES registry on October 16, 2023.

Q: What is Camillia 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 Camillia Clark was last updated on October 16, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since October 16, 2023PECOS Enrolled

452 D ST, IDAHO FALLS, ID 83402(208) 552-0355(208) 200-3201 Get Directions Write a Review

NPPES record last updated: October 16, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Camillia Clark Coui-9541 NPPES

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

CAMILLIA CLARK COUI-9541 (NPI 1528840584) is an individual mental health provider in Idaho Falls, Idaho, licensed in Idaho (COUI-9541) and active in the NPI registry since October 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1528840584

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameCAMILLIA CLARKCredential: COUI-9541

Location Address452 D STIdaho Falls, ID 83402-3531

Mailing Address452 D StIdaho Falls, ID 83402-3531 · (208) 552-0355 · Fax (208) 200-3201

Phone(208) 552-0355

Fax(208) 200-3201

Sole ProprietorNo

Enumeration DateOctober 16, 2023

NPPES CertifiedOctober 16, 2023

✔ NPI 1528840584 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 ID · COUI-9541

452 D ST, Idaho Falls, ID 83402

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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)

Camillia Clark Coui-9541 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.

Other Providers at the Same Location NPPES 2

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

KAMRYN JUDITH CARLSON LMSW

Social Worker

452 D ST
IDAHO FALLS, ID 83402

Bonneville County (208) 552-0355

MARTEN HATCH LCSW

Social Worker (Clinical)

452 D ST
IDAHO FALLS, ID 83402

Bonneville County (208) 552-0355

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 Camillia Clark's NPI number?

The NPI number for Camillia Clark is 1528840584. It was assigned to this individual provider in the NPPES registry on October 16, 2023.

Where is Camillia Clark located?

Camillia Clark practices at 452 D St, Idaho Falls, ID 83402. The listed phone number is (208) 552-0355.

What is Camillia Clark's specialty?

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

Is Camillia Clark enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Camillia Clark was last updated on October 16, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.