Kristina M Clark, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2398 Issued in WV

Practice address

511 Morris St
Charleston, WV 25301-1326

Phone

(304) 525-7851

Fax

(304) 525-1073

NPI assigned

Mar 13, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prestera Center for Mental Health Services IncGroup PAC ID 9234029307, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prestera Center for Mental Health Services Inc

  • Community/Behavioral Health Agency
  • Barboursville, WV
  • NPI 1356336903
  Medicare reassignment Care Compare group NPD
• Prestera Center for Mental Health Services Inc

  • Primary Care Clinic/Center
  • Huntington, WV
  • NPI 1992394860
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1083173702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 CRACKER BARREL DR STE 100",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255041650",
            "telephone_number": "304-525-7851",
            "fax_number": "304-525-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 MORRIS ST",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011326",
            "telephone_number": "304-525-7851",
            "fax_number": "304-525-1073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRISTINA",
        "middle_name": "M",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-13",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WV",
            "license": "2398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Paul Clark II, MD
• Jenna Clark
• Jonathon Clark
• Karen Clark
• Kayla Clark
• Kylee Clark
• Mackenzie Clark
• Makayla Clark
• Marsha Clark
• Mary Clark

• Mental Health Counselor in Charleston, WV
• Providers in Charleston, WV by specialty
• Mental Health Counselor in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.