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NPI Code Detail

MEDICARE: CORINE CLARK PMHNP-BC

MEDICARE: CORINE CLARK PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2363LP0808XPsychiatric/Mental Health Nurse PractitionerC-APN.0104659-C-NPCO
3363LP0808XPsychiatric/Mental Health Nurse Practitioner1140793TX

General Provider Information

NPI Number : 1881926616
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORINE CLARK PMHNP-BC
Provider Business Mailing Address
First Line : 3401 QUEBEC ST STE 7600
Second Line :
City : DENVER
State : CO
Zip : 80207-2345
Country : US
Telephone Number : 970-310-3406
Fax Number :
Provider Business Practice Location Address
First Line : 3401 QUEBEC ST STE 7600
Second Line :
City : DENVER
State : CO
Zip : 80207-2345
Country : US
Telephone Number : 970-310-3406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2010
Last Update Date : 09/15/2025

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Directions to “ CORINE CLARK PMHNP-BC” Practice Location

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