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Active NPI 1407251408 Individual Practitioner Male Practitioner

Nicklaus Clark , LPC, LMHC

Counselor - Professional • Gresham, OR

Professional Overview & Biography Verified Profile Summary

Nicklaus Clark, LPC, LMHC is a registered healthcare professional specializing in Counselor - Professional in Gresham, OR. Practice services are available at 1700 NW CIVIC DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1700 Nw Civic Dr
Suite 310

Gresham, OR 970303770

Telephone 5032335405
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Professional in Gresham, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 14.6 Yrs
State Avg: 13.7 Yrs
Regional Practice Density
35 Specialists

Practicing in Gresham, OR (2601 Statewide)

Telehealth Adoption Rate
2.9% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

State License OR C3550

Definition to come...

Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

State License WA LH60497951

Definition to come...

Counselor - Professional

NUCC Taxonomy Code: 101YP2500X

State License MO 2012024654

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

18 Associated Practitioners
Jennifer Pitt , LMFT

Marriage & Family Therapist

NPI 1013257542

Licensed Marriage and Family Therapist

Margo Pactanac , LCSW

Counselor - Mental Health

NPI 1063794261

Licensed Clinical Social Worker

Stephanie Mijo

Behavior Analyst

NPI 1093122806
Abigail Schultz , LPC

Counselor - Mental Health

NPI 1164036455

Licensed Professional Counselor

Robert Love , CRM

Counselor - Addiction (Substance Use Disorder)

NPI 1215717624
Ionela Cimpan

Student in an Organized Health Care Education/Training Program

NPI 1265834972

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active February 04, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location February 04, 2016

Registered at 1700 NW CIVIC DR, SUITE 310, GRESHAM, OR 970303770 (Tel: 5032335405)

📍
Updated Business Mailing Address February 04, 2016

Registered at PO BOX 82819, PORTLAND, OR 972820819 (Tel: 5032335405)

👤
Provider Name / Credentials Updated February 04, 2016

Recorded as NICKLAUS CLARK, LPC, LMHC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 04, 2016

Counselor (License #LH60497951 in WA)

🟢
Initial NPI Registration & Enumeration November 03, 2014

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1407251408
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 03, 2014
Last Update: February 04, 2016
Sole Proprietor: No

Mailing Address

Po Box 82819

Portland, OR 972820819

Phone: 5032335405

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.