Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Theresa L Clark, MD

Individual provider Psychiatry Physician · NPI 1104015155

Dr. Theresa L Clark, MD is a Psychiatry in Dillon, Colorado. Qualified in 2007, 19 years ago. Practices as a sole proprietor, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Colorado, Florida and Ohio.

Years since qualifying
19
Licensed in
CO, FL, OH
In the registry since
2007
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

114 Village Place St 207
Dillon, CO 80435
Phone: (970) 455-9004
Fax: (949) 577-4247
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 777 Bannock St, Denver, CO 80204-4507 — (303) 436-3000

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence DR.0061413 (CO)
Psychiatry Physician Taxonomy 2084P0800X · Licence 35.135479 (OH)
Psychiatry Physician Taxonomy 2084P0800X · Licence ME104695 (FL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence TRN11797 (FL)

Record details

NPI number1104015155
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedOctober 16, 2007
Last updated in NPPESMay 17, 2025
Certification dateMay 17, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPSYCHIATRY
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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