Shannon Clark, PHD
NPI 1649852930ActiveIndividual· Psychologist· Saint Louis, MO
Psychologist (PHD) in Saint Louis, Missouri, licensed in MO and UT, with an NPI issued in April 2021.
Overview
| NPI | 1649852930 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHD |
| Sole proprietor | Yes |
| NPI issued | Apr 26, 2021 |
| Last updated in NPPES | Aug 29, 2024 |
| Certified by provider | Aug 29, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist Primary | 103T00000X | 2021045663 | MO |
| Psychologist | 103T00000X | 12016019-2501 | UT |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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