Active NPI
Colleen Clark, LMHC
- Professional Counselor
- St Petersburg, FL
National Provider Identifier
1467936799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 15359
- Practice address
- 600 1St Ave N Ste 306
St Petersburg, FL 33701-3609 - Phone
- (727) 283-4184
- NPI assigned
- Sep 22, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | 15359 | FL | Primary |
Addresses
Primary practice location
600 1St Ave N Ste 306
St Petersburg, FL 33701-3609
Mailing address
600 1St Ave N Ste 306
St Petersburg, FL 33701-3609
Phone (727) 283-4184
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| O | Other | NONE |
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 |
|---|---|---|---|
| 15359 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635120000000",
"number": "1467936799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 1ST AVE N STE 306",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337013609",
"telephone_number": "727-283-4184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 1ST AVE N STE 306",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337013609",
"telephone_number": "727-283-4184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "COLLEEN",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-22",
"last_updated": "2021-10-25",
"certification_date": "2021-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "FL",
"license": "15359",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NONE",
"identifier": "O",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.