MARK W CLARK (PSY.D.) – Psychologist, NPI 1114081577

MARK W CLARK (PSY.D.) is a healthcare provider. based in Portland, Oregon. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PSY.D.. They hold a License No. PY2226 (WA). The NPI Number for MARK W CLARK (PSY.D.) is 1114081577

Main info

Male
30 Years Of Experience
Accepts Medicare Assignment
Name
MARK W CLARK (PSY.D.)
NPI
1114081577
Phone
(503) 233-5405
Address
PO BOX 82819
Enumeration Date
20 December 2006
Last Update Date
13 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3609061190
Graduation Year
1996 (30 years ago)
PAC ID
0143405829
Group Practice PAC ID
7719975085
Professional Enrollment ID
I20110421000841
Address ID
WA986626007VA7507XSTXX400
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience72
Completeness85
Years active:19State licenses:1Digital endpointsOther names

775 CLINICAL PSYCHOLOGIST in WA

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Provider Addresses for MARK W CLARK (PSY.D.)

  • UHY Crossleys, Station Road, Ballasalla, Malew, Rushen, IM99 6AB, Isle of Man

    PORTLAND, OR 972820819

    Phone: (503) 233-5405

    Fax: (503) 233-2696

    Type: Mailing

  • Western Psychological & Counseling, 7507, Northeast 51st Street, Vancouver, Clark County, Washington, 98662, United States

    VANCOUVER, WA 986626007

    Phone: (360) 906-1190

    Fax: (360) 906-1193

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2011-04-21

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20110421000841IClinical PsychologistWATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
90837Psychotherapy, 1 hour7914$0
View full utilization report →

Insurance plans in this area (ZIP 97282)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7719975085View full group profile
NameSpecialtyState
Nurse PractitionerOR
-WA
-OR
Clinical PsychologistOR
Clinical Social WorkerOR
Mental Health CounselorTX
Clinical Social WorkerCA
Clinical Social WorkerOR
Mental Health CounselorOR
-OR

Reviews

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Frequently asked questions

How is MARK W CLARK (PSY.D.) identified in CMS data?
CMS-hosted NPPES data lists MARK W CLARK (PSY.D.) with NPI 1114081577.
Does CMS list MARK W CLARK (PSY.D.) as active?
Yes — MARK W CLARK (PSY.D.) is active in the NPI listing used on this page.
What is MARK W CLARK (PSY.D.)'s primary classification?
Psychologist is the headline specialty for MARK W CLARK (PSY.D.) here. Clinical services aligned with this taxonomy classification.
Where should I expect MARK W CLARK (PSY.D.) on a map?
Expect Portland, Oregon as a primary anchor for MARK W CLARK (PSY.D.) unless the record lists multiple sites.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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