Active NPI
Tammy Evette Clark, LPC
- Professional Counselor
- Saint Louis, MO
National Provider Identifier
1154583268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2008011148
- Practice address
- 1133 Putter LN
Saint Louis, MO 63132-3806 - Phone
- (314) 994-9466
- NPI assigned
- Jun 30, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2008011148 | MO | Primary |
Addresses
Primary practice location
1133 Putter LN
Saint Louis, MO 63132-3806
Mailing address
1133 Putter LN
Saint Louis, MO 63132-3806
Phone (314) 994-9466
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 |
|---|---|---|---|
| 2008011148 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329868800000",
"number": "1154583268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1133 PUTTER LN",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631323806",
"telephone_number": "314-994-9466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 PUTTER LN",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631323806",
"telephone_number": "314-994-9466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TAMMY",
"middle_name": "EVETTE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-30",
"last_updated": "2012-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2008011148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.