Kaitlyn Mary Clark, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC012288 Issued in GA

Practice address

3760 Lavista Rd Ste 102
Tucker, GA 30084-5622

Phone

(770) 375-8124

Fax

(770) 559-5543

NPI assigned

Nov 19, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kaitlyn Mary Bartfay Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Henderson Behavioral Health, Inc.

  • Family Medicine Physician
  • Ft Lauderdale, FL
  • NPI 1053262709
  NPD (past)
• Henderson Behavioral Health, Inc.

  • Community/Behavioral Health Agency
  • Lauderdale Lakes, FL
  • NPI 1972533271
  NPD (past)

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

{
    "created_epoch": "1447891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1457725095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 LAVISTA RD STE 102",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845622",
            "telephone_number": "770-375-8124",
            "fax_number": "770-559-5543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 LAVISTA RD STE 102",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845622",
            "telephone_number": "770-375-8124",
            "fax_number": "770-559-5543"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1370 Center Dr Ste 205",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303384132",
            "country_code": "US",
            "telephone_number": "770-375-8124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KAITLYN",
        "middle_name": "MARY",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-19",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC012288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "BARTFAY",
            "middle_name": "MARY",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joshua Chung, PHARMD
• Ashley Church, APC, NCC
• City Psychiatry LLC
• City to City Psychiatric Services
• Julia Marie Clark, PA
• Kaylen Clark
• Meghan Clark, M.S.
• Clearstone Counseling LLC
• Coby Laboratories & Screening, LLC
• Bridget T Coffey, RD

• Professional Counselor in Tucker, GA
• Providers in Tucker, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.