1801802855 NPI number — DR. DESSYE-DEE M CLARK ARNP, PHD

Table of content: DR. DESSYE-DEE M CLARK ARNP, PHD (NPI 1801802855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801802855 NPI number — DR. DESSYE-DEE M CLARK ARNP, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARK
Provider First Name:
DESSYE-DEE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ARNP, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARK
Provider Other First Name:
DESSYE-DEE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801802855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 W SPRUCE ST
Provider Second Line Business Mailing Address:
SOUND VIEW COUNSELING & ASSOC. PS INC.
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59802-4107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-541-4436
Provider Business Mailing Address Fax Number:
406-541-4437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W SPRUCE ST
Provider Second Line Business Practice Location Address:
SOUND VIEW COUNSELING & ASSOC. PS INC.
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59802-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-541-4436
Provider Business Practice Location Address Fax Number:
406-541-4437
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  283297 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN00094578 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: RN29998 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 30002196 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0807X , with the licence number: RN29998 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0807X , with the licence number: AP30002196 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X , with the licence number: RN29998 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X , with the licence number: AP30002196 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: NUR-APRN-LIC-99982 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0004304872 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29998 . This is a "APRN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 30002196 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".