MEDICARE: DR. NINA CLARK PSYD, LPC

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
1	101YM0800X	Mental Health Counselor	C10778	OR
2	101YM0800X	Mental Health Counselor	173084	AK
3	101YM0800X	Mental Health Counselor	MHPL.MX.70036452	WA

General Provider Information

NPI Number	:	1982276077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NINA CLARK PSYD, LPC

Provider Business Mailing Address
First Line	:	15261 SNOW FLAKE DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-4435
Country	:	US
Telephone Number	:	907-331-8854
Fax Number	:

Provider Business Practice Location Address
First Line	:	15261 SNOW FLAKE DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-4435
Country	:	US
Telephone Number	:	907-331-8854
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	06/10/2026

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