TERYL L CLARK LCSW
NPI 1588097786
Counselor - Professional in American Fork, UT
About Teryl L Clark Lcsw NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TERYL L CLARK LCSW (NPI 1588097786) is an individual professional provider in American Fork, Utah, licensed in Utah (5970987-3501) and active in the NPI registry since August 2013. She has opted out of Medicare through April 1, 2027 and remains eligible to order and refer.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Teryl L Clark Lcsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2017 through April 1, 2027.
Other Providers at the Same Location NPPES 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Teryl Clark's NPI number?
The NPI number for Teryl Clark is 1588097786. It was assigned to this individual provider in the NPPES registry on August 12, 2013.
Where is Teryl Clark located?
Teryl Clark practices at 789 Bamberger Dr Suite A, American Fork, UT 84003. The listed phone number is (801) 915-8792.
What is Teryl Clark's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Teryl Clark enrolled in Medicare?
No. Teryl Clark has opted out of Medicare through April 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.
When was this NPI record last updated?
The NPPES record for Teryl Clark was last updated on August 12, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.
# Teryl L Clark, LCSW · NPI 1588097786
Professional provider in American Fork, Utah. Individual provider, active in the CMS NPPES registry since August 12, 2013.
## Identity
- **NPI:** 1588097786 (Entity type: Individual)
- **Enumerated:** August 12, 2013
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 5970987-3501 (Utah)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 789 BAMBERGER DR, SUITE A, American Fork, UT 84003-2181
- **Phone:** (801) 915-8792
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through April 1, 2027); services are provided under private contract
## Record status
- **NPPES last updated:** August 12, 2013
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Source: [NPI Profile](https://npiprofile.com/npi/1588097786) · Data from the CMS NPPES public registry.