Active NPI
Christopher Alex Clark, LMFT
- Mental Health Counselor
- Wilmore, KY
National Provider Identifier
1144657248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 169304
- Practice address
- 900 Corbitt Dr
Wilmore, KY 40390-1096 - Phone
- (859) 806-9813
- NPI assigned
- Oct 3, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 169304 | KY | Primary |
Addresses
Primary practice location
900 Corbitt Dr
Wilmore, KY 40390-1096
Mailing address
900 Corbitt Dr
Wilmore, KY 40390-1096
Phone (859) 806-9813
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 169304 | KY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595376000000",
"number": "1144657248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 CORBITT DR",
"city": "WILMORE",
"state": "KY",
"postal_code": "403901096",
"telephone_number": "859-806-9813",
"fax_number": "606-886-4433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 CORBITT DR",
"city": "WILMORE",
"state": "KY",
"postal_code": "403901096",
"telephone_number": "859-806-9813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHRISTOPHER",
"middle_name": "ALEX",
"name_prefix": "Mr.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-03",
"last_updated": "2020-07-22",
"certification_date": "2020-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "KY",
"license": "169304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmore, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.