Healthcare Provider Details

I. General information

NPI: 1003384843
Provider Name (Legal Business Name): TOMAS CLARKE MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 30TH ST SW
ROCHESTER MN
55902-1132
US

IV. Provider business mailing address

1224 EASTGATE DR SE # 8028
ROCHESTER MN
55904-5716
US

V. Phone/Fax

Practice location:
  • Phone: 719-283-1570
  • Fax:
Mailing address:
  • Phone: 720-446-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5689
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016613
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: