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Jesse Wayne Clark , LPCC

Counselor - Professional β€’ Dayton, OH

Active NPI 1730517087 Individual Practitioner Male Practitioner
Practice location in NPPES

65 Grady Ct
Dayton, OH 45409

Call 9374164031 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

65 Grady Ct

Dayton, OH 45409

Telephone 9374164031
Organization at the Same NPPES Address or Phone
St. Joseph Orphanage Facility NPI 1467991752

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Other Listings in Public Data

NPPES lists 1 additional practice-address record in Monroe, OH. See the list

Source: CMS NPPES NPI Registry, practice location records; release date unavailable.

Listings do not confirm current availability, employment or a shared ownership network.

NPI first issued

2013

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Jesse Clark has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Can order Medicare-covered services

CMS lists Jesse Clark as eligible to order or refer Medicare Part B clinical laboratory and imaging services and durable medical equipment (DME) for people with Medicare.

What this does not show: Can order Medicare-covered services

It does not mean the clinician offers these services directly.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What ordering and referring status means

Compared with the same specialty in Dayton and Ohio

130 active clinicians are listed under Counselor - Professional with a practice address in Dayton, OH (6,790 in Ohio).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Dayton

6.9% of these 130 clinicians have the CMS telehealth indicator.

11.5% of these 130 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2026-02-24
Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

License # reported to NPPES OH E.1600066
Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: State Medical Board of Ohio.
Look Up on State Board Site

Medicare (PECOS) Enrollment & Ordering Eligibility

Source: CMS PECOS
Medicare FFS Enrollment Status Medicare Enrollment on File
CMS Provider Specialty

PRACTITIONER - MENTAL HEALTH COUNSELOR

Medicare Enrollment ID

I20240422001149

Enrollment State Jurisdiction

OH

PECOS Control ID

9537508742

Medicare Order & Referring Eligibility
Clinical Lab & Imaging (Part B) Eligible
Durable Medical Equipment (DME) Eligible
Home Health Agency (HHA) Not Eligible
Power Mobility Devices (PMD) Not Eligible

Sources: CMS Provider Enrollment and Order and Referring. Medicare enrollment is a billing status, not an accreditation or quality rating.

Secondary Practice Locations

65 Grady Ct

Dayton, OH 454091151

Phone: 9374164031

30 Overbrook Dr Ste C

Monroe, OH 450501168

Phone: 5135395250

65 Grady Ct

Dayton, OH 454091151

Phone: 9374164031

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

15 Historical Events
πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) February 24, 2026

Counselor (license number reported to NPPES: OH E.1600066)

πŸ“
Updated Practice Location August 02, 2018

Registered at 65 GRADY CT, DAYTON, OH 45409 (Tel: 9374164031)

πŸ“
Updated Business Mailing Address August 02, 2018

Registered at 5400 EDALBERT DR, CINCINNATI, OH 452397604 (Tel: 9374164031)

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) March 17, 2018

Counselor (license number reported to NPPES: OH C.1200356)

βœ…
NPI Profile Active October 13, 2017

NPI status registered as active in NPPES database

πŸ“
Updated Practice Location October 13, 2017

Registered at 65 GRADY CT, DAYTON, OH 454091151 (Tel: 9374164031)

πŸ“
Updated Business Mailing Address October 13, 2017

Registered at 3095 KETTERING BLVD, MORAINE, OH 454391983 (Tel: 9372938300)

πŸ‘€
Provider Name / Credentials Updated October 13, 2017

Recorded as JESSE CLARK, LPCC

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) October 13, 2017

Counselor (license number reported to NPPES: OH E.1600066)

βœ…
NPI Profile Active October 24, 2013

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) October 24, 2013

Registered at 3095 KETTERING BLVD, MORAINE, OH 454391983 (Tel: 9372938300)

πŸ“
Business Mailing Address (Initial Record) October 24, 2013

Registered at 3095 KETTERING BLVD, MORAINE, OH 454391983 (Tel: 9372938300)

πŸ‘€
Provider Name / Credentials (Initial Record) October 24, 2013

Recorded as JESSE CLARK, PC

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) October 24, 2013

Counselor (license number reported to NPPES: OH C.1200356)

🟒
Initial NPI Registration & Enumeration October 24, 2013

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1730517087
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 24, 2013
Last Update: February 24, 2026
Sole Proprietor: No

Mailing Address

5400 Edalbert Dr

Cincinnati, OH 452397604

Phone: 9374164031

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.