DR. BRUCE E CLARK PH.D.
NPI 1669212395
Psychologist in St Louis Park, MN

Active since May 30, 2024PECOS Enrolled
3800 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416(952) 993-3123(952) 993-3286 Get Directions Write a Review

NPPES record last updated: August 9, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Bruce E Clark Ph.d. NPPES

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

DR. BRUCE E CLARK PH.D. (NPI 1669212395) is an individual psychologist in St Louis Park, Minnesota, licensed in Minnesota (LP7036) and active in the NPI registry since May 2024. He is enrolled in Medicare PECOS, maintains a secondary practice location in Robbinsdale, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1669212395
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. BRUCE E CLARKCredential: PH.D.
Location Address3800 PARK NICOLLET BLVDSt Louis Park, MN 55416-2527
Mailing Address8170 33rd Ave S # Ms 21110qBloomington, MN 55425-4516
Fax(952) 993-3286
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateMay 30, 2024
Last NPPES UpdateAugust 9, 2024
NPPES CertifiedAugust 9, 2024
NPI 1669212395 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in MN · LP7036
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License LP7036 (MN)
3800 PARK NICOLLET BLVD, St Louis Park, MN 55416

Secondary Practice Location 1

Location 13366 Oakdale Ave N Ste 315Robbinsdale, MN 55422-2967 · Phone (763) 581-5372

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Bruce E Clark Ph.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5799225710
PECOS Enrollment IDI20250812000593
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 20

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

Psychologist
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Physical Medicine & Rehabilitation
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Internal Medicine (Endocrinology, Diabetes & Metabolism)
3800 PARK NICOLLET BLVD
MINNEAPOLIS, MN 55416
Physician Assistant
3800 PARK NICOLLET BLVD, DEPARTMENT OF DERMATOLOGY
ST LOUIS PARK, MN 55416
Dermatology
3800 PARK NICOLLET BLVD, DERMATOLOGY 4TH FLOOR
ST LOUIS PARK, MN 55416
Psychologist (Clinical)
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Dermatology
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Radiology (Diagnostic Radiology)
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416

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 Bruce Clark's NPI number?

The NPI number for Bruce Clark is 1669212395. It was assigned to this individual provider in the NPPES registry on May 30, 2024.

Where is Bruce Clark located?

Bruce Clark practices at 3800 Park Nicollet Blvd, St Louis Park, MN 55416. The listed phone number is (952) 993-3123.

What is Bruce Clark's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Bruce Clark enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Bruce Clark was last updated on August 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.