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JACEY CLARK CDPT
NPI 1730676701
Counselor in Longview, WA

Active since April 16, 2018
720 14TH AVENUE, LONGVIEW, WA 98632(360) 353-9840(360) 353-9880 Get Directions Write a Review

NPPES record last updated: May 1, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 1, 2019, Apr 16, 2018 (2 updates tracked since 2018).

About Jacey Clark Cdpt NPPES

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

JACEY CLARK CDPT (NPI 1730676701) is an individual counselor in Longview, Washington, licensed in Washington (60823909) and active in the NPI registry since April 2018.

NPPES Registry Identity

NPI1730676701
Entity TypeIndividualMale
Primary Taxonomy101Y00000X
Provider Legal NameJACEY CLARKCredential: CDPT
Location Address720 14TH AVENUELongview, WA 98632
Mailing Address921 14th AvenueLongview, WA 98632 · (360) 423-0203 · Fax (360) 577-0269
Phone(360) 353-9840
Fax(360) 353-9880
Sole ProprietorNo
Enumeration DateApril 16, 2018
Last NPPES UpdateMay 1, 20192 updates tracked since enumeration
✔ NPI 1730676701 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
License✔ Licensed in WA · 60823909
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
720 14TH AVENUE, Longview, WA 98632
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Other Identifiers 1

Medicaid2101625WA

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.

CONSTANCE SHAMP
Counselor (Mental Health)
720 14TH AVENUE
LONGVIEW, WA 98632
Cowlitz County (360) 423-0203
SAMANTHA TAYLOR
Counselor (Mental Health)
720 14TH AVENUE
LONGVIEW, WA 98632
Cowlitz County (360) 423-0203
JOSH IPOCK CAAR
Counselor
720 14TH AVENUE
LONGVIEW, WA 98632
Cowlitz County (360) 423-0203
CHRISTINA MARIE FLOHR LMP
Counselor
720 14TH AVENUE
LONGVIEW, WA 98632
Cowlitz County (360) 423-0203
REBECCA GLOSE LCSW
Social Worker (Clinical)
720 14TH AVENUE
LONGVIEW, WA 98632
Cowlitz County (360) 423-0203
KALA JOHNSON
Registered Nurse
720 14TH AVENUE
LONGVIEW, WA 98632
Cowlitz County (360) 353-9840
MRS. EMILY SEAMAN
Counselor
720 14TH AVENUE
LONGVIEW, WA 98632
Cowlitz County (360) 423-0203
MRS. JAYME NICOLE CULLETT
Counselor (Mental Health)
720 14TH AVENUE
LONGVIEW, WA 98632
Cowlitz County (360) 423-0203

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 Jacey Clark's NPI number?

The NPI number for Jacey Clark is 1730676701. It was assigned to this individual provider in the NPPES registry on April 16, 2018.

Where is Jacey Clark located?

Jacey Clark practices at 720 14th Avenue, Longview, WA 98632. The listed phone number is (360) 353-9840.

What is Jacey Clark's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

When was this NPI record last updated?

The NPPES record for Jacey Clark was last updated on May 1, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.