Heather Jean Clark, MA, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PC014131 Issued in PA

Practice address

43 Village of Stoney Run Apt F
Maple Shade, NJ 08052-2143

Phone

(609) 617-4604

NPI assigned

May 24, 2022

Last updated

Jul 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 PA

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Indlovu LLCGroup PAC ID 2961853353, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

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

• Indlovu, LLC

  dba Ellie Mental Health Philadelphia

  • Mental Health Counselor
  • Philadelphia, PA
  • NPI 1619661584
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1653350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1144968694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 VILLAGE OF STONEY RUN APT F",
            "city": "MAPLE SHADE",
            "state": "NJ",
            "postal_code": "080522143",
            "telephone_number": "609-617-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 VILLAGE OF STONEY RUN APT F",
            "city": "MAPLE SHADE",
            "state": "NJ",
            "postal_code": "080522143",
            "telephone_number": "609-617-4604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 S 17th St Fl 9",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191036209",
            "country_code": "US",
            "telephone_number": "215-608-0040",
            "fax_number": "267-227-9989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "HEATHER",
        "middle_name": "JEAN",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-24",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "PC014131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Bortner, RN, IBCLC
• Virginia Brodie, LCSW
• Matthew Bryant
• Bumblebee Health LLC
• Jessica Cerasaro
• Comfort Care Zone LLC
• Comfort Care Zone, LLC
• Bridget Conaway, LPN
• Renae Cuffari
• Dayna Monay Cunningham, ABA THERAPIST OR BT

• Mental Health Counselor in Maple Shade, NJ
• Providers in Maple Shade, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.