NPIMap

Individual provider Active NPI

Kristie Ann Clark, LPC

  • Professional Counselor
  • Saginaw, MI
National Provider Identifier
1376928366
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401011076 Issued in MI
Practice address
5090 State St
Suite 102-B
Saginaw, MI 48603-7706
Phone
(479) 685-7830
NPI assigned
Jul 20, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401011076 MI Primary

Addresses

Primary practice location

5090 State St
Suite 102-B
Saginaw, MI 48603-7706

Mailing address

5090 State St
Suite 102-B
Saginaw, MI 48603-7706
Phone (479) 685-7830

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

LicenseStateTypeSpecialty
6401011076MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kristie Clark, PLLC Current Accepting new patients
Katherine Arkell and Associates Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1376928366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5090 STATE ST",
            "address_2": "SUITE 102-B",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486037706",
            "telephone_number": "479-685-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5090 STATE ST",
            "address_2": "SUITE 102-B",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486037706",
            "telephone_number": "479-685-7830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRISTIE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-20",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401011076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.