Active NPI
Latarious Clark
- Professional Counselor
- Athens, GA
National Provider Identifier
1659827673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC009108
- Practice address
- 135 Brentwood Dr
Athens, GA 30605-3901 - Phone
- (706) 224-4851
- NPI assigned
- Aug 30, 2016
- 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 | LPC009108 | GA | Primary |
Addresses
Primary practice location
135 Brentwood Dr
Athens, GA 30605-3901
Mailing address
135 Brentwood Dr
Athens, GA 30605-3901
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241211003871 | GA | Practitioner - Mental Health Counselor | 8224564448 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advantage Behavioral Health Systems | Current | Accepting new patients |
Locations
240 Mitchell Bridge Rd
Athens, GA 30606
Phone (706) 369-5745
250 Bray St
Athens, GA 30601
Phone (706) 542-9746
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Athens, GA
- NPI 1942270558
GA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472515200000",
"number": "1659827673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 BRENTWOOD DR",
"city": "ATHENS",
"state": "GA",
"postal_code": "306053901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 BRENTWOOD DR",
"city": "ATHENS",
"state": "GA",
"postal_code": "306053901",
"telephone_number": "706-224-4851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LATARIOUS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-30",
"last_updated": "2016-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC009108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.