Clark, Nicklaus

Clark, Nicklaus is an individual health care provider with primary practice located at 1700 Nw Civic Dr Suite 310, Gresham OR 97030-3770. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Clark, Nicklaus can be contacted via phone (503) 233-5405.

Contact Information

Primary practice address
1700 Nw Civic Dr Suite 310 Gresham OR 97030-3770
Phone: (503) 233-5405
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X LH60497951 Washington
Behavioral Health & Social Service Providers / Professional 101YP2500X C3550 Oregon
Behavioral Health & Social Service Providers / Professional 101YP2500X 2012024654 Missouri

Profile Details

NPI number 1407251408
LBN Legal business name Clark, Nicklaus
Credentials LPC, LMHC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2014
Last updated Feb 4th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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