Nicklaus Clark, LPC, LMHC in Gresham, OR - Medicare Counselor Provider

Nicklaus Clark, LPC, LMHC is a medicare enrolled "Counselor - Professional" provider in Gresham, Oregon. His current practice location is 1700 Nw Civic Dr, Suite 310, Gresham, Oregon. You can reach out to his office (for appointments etc.) via phone at (503) 233-5405.

Nicklaus Clark is licensed to practice in Oregon (license number C3550) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1407251408.

Contact Information

	Nicklaus Clark, LPC, LMHC
	1700 Nw Civic Dr, Suite 310, Gresham, OR 97030-3770
	(503) 233-5405
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Nicklaus Clark
Gender	Male
Speciality	Counselor - Professional
Location	1700 Nw Civic Dr, Gresham, Oregon
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1407251408
Provider Enumeration Date: 11/03/2014
Last Update Date: 02/04/2016

Medicare PECOS Information:

PECOS PAC ID: 8325584386
Enrollment ID: I20240725003988

Medical Identifiers

Medical identifiers for Nicklaus Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1407251408	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YM0800X	Counselor - Mental Health	LH60497951 (Washington)	Secondary
101YP2500X	Counselor - Professional	C3550 (Oregon)	Primary
101YP2500X	Counselor - Professional	2012024654 (Missouri)	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Nicklaus Clark allows following entities to bill medicare on his behalf.

Entity Name	Brightspire Health Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1518656776 PECOS PAC ID: 2163866419 Enrollment ID: O20240215000298

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Nicklaus Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Nicklaus Clark, LPC, LMHC Po Box 82819, Portland, OR 97282-0819 Ph: (503) 233-5405	Nicklaus Clark, LPC, LMHC 1700 Nw Civic Dr, Suite 310, Gresham, OR 97030-3770 Ph: (503) 233-5405

Reviews and Comments

Counselor in Gresham, OR

Deanna Rae Shields, CADC-R/CHW/CRM/PSS Counselor Medicare: Not Enrolled in Medicare Practice Location: 355 Nw Division St, Gresham, OR 97030 Phone: 503-231-2641 Fax: 503-231-1654
Amy Marie Elness, CADC II/QMHA-R Counselor Medicare: Not Enrolled in Medicare Practice Location: 620 Ne 2nd St, Gresham, OR 97030 Phone: 971-274-3757 Fax: 503-912-5740
Joey Owen Patton, Counselor Medicare: Not Enrolled in Medicare Practice Location: 750 E Powell Blvd, Gresham, OR 97030 Phone: 360-977-0450
Mr. Sammy Travis Freshner Jr., M.ED, MAC, LPCRA Counselor Medicare: Not Enrolled in Medicare Practice Location: 1584 Ne 8th St Ste 200, Gresham, OR 97030 Phone: 503-890-8773
Laurie Anne Ricken, B.A. Counselor Medicare: Not Enrolled in Medicare Practice Location: 400 Ne 7th St, Gresham, OR 97030 Phone: 503-661-5455
Mr. David J. Lowe, M.A., LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1890 Ne Cleveland Ave, Gresham, OR 97030 Phone: 503-492-1200
Drake Miyake, MSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 831 Nw Council Dr Ste 300, Gresham, OR 97030 Phone: 503-258-4600

Nicklaus Clark, LPC, LMHC - Medicare Counselor in Gresham, OR