Active NPI
Amy Clark, LPCC
- Professional Counselor
- Florence, KY
National Provider Identifier
1609262195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1339
- Practice address
- 7459 Burlington Pike
Florence, KY 41042-1553 - Phone
- (859) 331-3292
- Fax
- (859) 578-2864
- NPI assigned
- Apr 10, 2015
- Sex
- Female
- Sole proprietor
- No
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 | 1339 | KY | Primary |
Addresses
Primary practice location
7459 Burlington Pike
Florence, KY 41042-1553
Mailing address
502 Farrell Dr
Covington, KY 41011-3717
Phone (859) 578-3204
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 610661458 | Other | KY | TAX ID |
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 |
|---|---|---|---|
| 1339 | KY | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428624000000",
"number": "1609262195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "502 FARRELL DR",
"city": "COVINGTON",
"state": "KY",
"postal_code": "410113717",
"telephone_number": "859-578-3204",
"fax_number": "859-578-3273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7459 BURLINGTON PIKE",
"city": "FLORENCE",
"state": "KY",
"postal_code": "410421553",
"telephone_number": "859-331-3292",
"fax_number": "859-578-2864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "AMY",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-10",
"last_updated": "2015-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KY",
"license": "1339",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "610661458",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Florence, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.