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

Jeremy Keith Clark

Individual provider Marriage & Family Therapist · NPI 1356958383

Jeremy Keith Clark is a Marriage and Family Therapist in Ogden, Utah. Qualified in 2021, 5 years ago. Practices as a sole proprietor.

Years since qualifying
5
In the registry since
2020
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Practice location Address checks out

1525 Lincoln Ave
Ogden, UT 84404-5638
Phone: (801) 621-6510
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Marriage & Family Therapist (primary) Taxonomy 106H00000X

Record details

NPI number1356958383
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 24, 2020
Last updated in NPPESSeptember 24, 2020
Certification dateSeptember 24, 2020

Medicare enrollment

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

Medicare specialtyMARRIAGE AND FAMILY THERAPIST
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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