Kimberly Deyonne Clark, CMHT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

2803 Old North Hills St
Meridian, MS 39305-1630

Phone

(601) 435-2919

Fax

(601) 286-5054

NPI assigned

Apr 26, 2023

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 26, 2023.

{
    "created_epoch": "1682467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1407544604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2803 OLD NORTH HILLS ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393051630",
            "telephone_number": "601-435-2919",
            "fax_number": "601-286-5054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2803 OLD NORTH HILLS ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393051630",
            "telephone_number": "601-435-2919",
            "fax_number": "601-286-5054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "middle_name": "DEYONNE",
        "credential": "CMHT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-26",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Clanton
• Claripath Counseling and Consulting LLC
• Clark Chiropractic Clinic PA
• Grady Mims Clark Jr., O.D.
• James Eugene Clark, D.D.S.
• Robert E Clark, M.D.
• Ronald H Clark, DC
• Sandra Denice Clark, ED.S
• Clarkdale Pharmacy and Gifts LLC
• Demetrius Clay, LPC, ED.S, MS

• All providers in Meridian, MS
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; 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.