Active NPI
Renee Clark, LPC
- Professional Counselor
- Leavenworth, KS
National Provider Identifier
1306001540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1921
- Practice address
- 500 Limit St
Leavenworth, KS 66048-4435 - Phone
- (913) 682-5118
- Fax
- (913) 682-4664
- NPI assigned
- Jul 28, 2008
- Sex
- Female
- Sole proprietor
- No
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 | 1921 | KS | Primary |
Addresses
Primary practice location
500 Limit St
Leavenworth, KS 66048-4435
Mailing address
21055 175TH St
Tonganoxie, KS 66086-5365
Phone (913) 682-5118
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 |
|---|---|---|---|
| 1921 | KS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217203200000",
"number": "1306001540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21055 175TH ST",
"city": "TONGANOXIE",
"state": "KS",
"postal_code": "660865365",
"telephone_number": "913-682-5118",
"fax_number": "913-682-4664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 LIMIT ST",
"city": "LEAVENWORTH",
"state": "KS",
"postal_code": "660484435",
"telephone_number": "913-682-5118",
"fax_number": "913-682-4664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RENEE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-28",
"last_updated": "2008-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KS",
"license": "1921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leavenworth, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.