Active NPI
Kindra Threlkeld Bernard, LCPC
- Professional Counselor
- Portland, ME
National Provider Identifier
1619080132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CC3547
- Practice address
- 200 High St
Suite 2C
Portland, ME 04101-2831 - Phone
- (207) 251-5359
- NPI assigned
- Aug 17, 2006
- 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 | CC3547 | ME | Primary |
Addresses
Primary practice location
200 High St
Suite 2C
Portland, ME 04101-2831
Mailing address
200 High St
Suite 2C
Portland, ME 04101-2831
Phone (207) 251-5359
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 432160299 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 8, 2024 through Nov 8, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC3547 | ME | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319500800000",
"number": "1619080132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 HIGH ST",
"address_2": "SUITE 2C",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041012831",
"telephone_number": "207-251-5359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HIGH ST",
"address_2": "SUITE 2C",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041012831",
"telephone_number": "207-251-5359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERNARD",
"first_name": "KINDRA",
"middle_name": "THRELKELD",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-17",
"last_updated": "2011-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ME",
"license": "CC3547",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "432160299",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.