Mrs Nicole Lane Clark, LCSW in Shingletown, CA - Medicare Clinical Social Worker Provider

Mrs Nicole Lane Clark, LCSW is a medicare enrolled "Counselor - Mental Health" provider in Shingletown, California. She graduated from healthcare school in 2013 and has 13 years of diverse experience with area of expertise as Clinical Social Worker. She is a member of the group practice Shingletown Medical Center and her current practice location is 31292 Alpine Meadows Rd, Shingletown, California. You can reach out to her office (for appointments etc.) via phone at (530) 474-3390.

Mrs Nicole Lane Clark is licensed to practice in California (license number 91794) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1467893032.

Contact Information

	Mrs Nicole Lane Clark, LCSW
	31292 Alpine Meadows Rd, Shingletown, CA 96088-9462
	(530) 474-3390
	(530) 474-1407

Map and Direction

Healthcare Provider's Profile

Full Name	Mrs Nicole Lane Clark
Gender	Female
Speciality	Clinical Social Worker
Experience	13 Years
Location	31292 Alpine Meadows Rd, Shingletown, California
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Mrs Nicole Lane Clark graduated from medical school in 2013

NPI Data:

NPI Number: 1467893032
Provider Enumeration Date: 07/11/2013
Last Update Date: 05/21/2021

Medicare PECOS Information:

PECOS PAC ID: 6305364555
Enrollment ID: I20250520004690

Medical Identifiers

Medical identifiers for Mrs Nicole Lane Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1467893032	NPI	-	NPPES
95-2633765	Other	CA	MEDI-CAL

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YM0800X	Counselor - Mental Health	91794 (California)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Shingletown Medical Center	5294720736	11

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Nicole Lane Clark allows following entities to bill medicare on her behalf.

Entity Name	Shingletown Medical Center
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1750387072 PECOS PAC ID: 5294720736 Enrollment ID: O20040428000723

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Nicole Lane Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Nicole Lane Clark, LCSW 1005 Magnolia Ave, Redding, CA 96001-0314 Ph: (530) 209-5545	Mrs Nicole Lane Clark, LCSW 31292 Alpine Meadows Rd, Shingletown, CA 96088-9462 Ph: (530) 474-3390

Mrs Nicole Lane Clark, LCSW - Medicare Counselor in Shingletown, CA