Tina W Embry, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P0207029 Issued in AR

Practice address

625 Clifton St
Camden, AR 71701-3327

Phone

(870) 836-9362

Fax

(870) 836-9363

NPI assigned

Jan 30, 2006

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 2, 2019.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575244800000",
    "number": "1497726236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 CLIFTON ST",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717013327",
            "telephone_number": "870-836-9362",
            "fax_number": "870-836-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 CLIFTON ST",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717013327",
            "telephone_number": "870-836-9362",
            "fax_number": "870-836-9363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMBRY",
        "first_name": "TINA",
        "middle_name": "W",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2019-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P0207029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN NETWORK NUMBER",
            "identifier": "302413",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "5W957",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Camden, AR
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; 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.