Individual provider Active NPI

Kimberly Clark

  • Mental Health Counselor
  • Tampa, FL
National Provider Identifier
1497236301
Registry record updated Sep 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH23885 Issued in FL
Practice address
4107 W Spruce St Ste 100
Tampa, FL 33607-2346
Phone
(813) 636-8811
Fax
(813) 636-8855
NPI assigned
Aug 28, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH23885 FL Primary

Addresses

Primary practice location

4107 W Spruce St Ste 100
Tampa, FL 33607-2346

Mailing address

4107 W Spruce St Ste 100
Tampa, FL 33607-2346
Phone (813) 636-8811

Other identifiers 1

IdentifierTypeStateIssuer
123343100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20240820004192 FL Practitioner - Mental Health Counselor 0446798524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Neuropsychiatric Institute, LLCGroup PAC ID 5698936037, 16 clinicians

Practice addresses (Care Compare)

4107 W Spruce St
Suite 100
Tampa, FL 33607-2346
Phone (813) 636-8811

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH23885FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Neuropsychiatric Institute, LLC CurrentSince Aug 12, 2024 Accepting new patients

Locations

4107 W Spruce St
Ste 100
Tampa, FL 33607
Phone (813) 636-8811

Organizations & group practices 1

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": "1535414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757980800000",
    "number": "1497236301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4107 W SPRUCE ST STE 100",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336072346",
            "telephone_number": "813-636-8811",
            "fax_number": "813-636-8855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4107 W SPRUCE ST STE 100",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336072346",
            "telephone_number": "813-636-8811",
            "fax_number": "813-636-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-28",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH23885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123343100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.