Individual ProviderCarley Marie ClarkSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1600 Specht Point Rd Ste 105, Fort Collins, CO 80525-4311(970) 494-5891(419) 695-8010PECOS EnrollmentBased on the most recent information from CMS, provider Carley Marie Clark does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1457834061Provider TypeIndividualFull NameClark, Carley MarieCredentialLCSWGenderFemaleSole ProprietorNoEnumeration Date9/10/2018Last Updated10/17/2024Contact InformationPractice LocationPractice Address1600 Specht Point Rd Ste 105, Fort Collins, CO 80525-4311Phone(970) 494-5891Fax(970) 494-5885Mailing LocationMailing Address10100 Elida Rd, Delphos, OH 45833-9056Phone(419) 695-8010Fax(419) 695-8010Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseCSW.09930938ColoradoCode171M00000XDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer