Individual provider Active NPI

Amber Clark, LPC

  • Professional Counselor
  • Bentonville, AR
National Provider Identifier
1417379751
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
P1602013 Issued in AR
Practice address
2003 SE Walton Blvd
Bentonville, AR 72712-3725
Phone
(479) 750-2020
Fax
(479) 750-4843
NPI assigned
Jan 6, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X AR
Professional Counselor 101YP2500X P1602013 AR Primary

Addresses

Primary practice location

2003 SE Walton Blvd
Bentonville, AR 72712-3725

Mailing address

2400 S 48TH St
Springdale, AR 72762-6683
Phone (479) 750-2020

Other practice location 1

1200 W Walnut St Ste 1400
Rogers, AR 72756-3598
Phone (479) 725-6000

Other practice location 2

1200 W Walnut St Ste 200
Rogers, AR 72756-3521
Phone (479) 750-2020

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
P1602013ARMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Anchored Hearts Counseling Services, LLC Professional Current Accepting new patients
Ozark Guidance Center, Inc 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": "1388966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1417379751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 S 48TH ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626683",
            "telephone_number": "479-750-2020",
            "fax_number": "479-750-4843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 SE WALTON BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123725",
            "telephone_number": "479-750-2020",
            "fax_number": "479-750-4843"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 W Walnut St Ste 1400",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727563598",
            "country_code": "US",
            "telephone_number": "479-725-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 W Walnut St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727563521",
            "country_code": "US",
            "telephone_number": "479-750-2020",
            "fax_number": "479-750-4843",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "AMBER",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-06",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1602013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.