Active NPI
Mary Katherine Clark, M.S.,LPE-I
- School Psychologist
- Greenwood, AR
National Provider Identifier
1750546693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 83-07E-I
- Practice address
- 320 N Main St
Greenwood, AR 72936-7031 - Phone
- (479) 996-1414
- NPI assigned
- Jul 21, 2008
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 83-07E-I | AR | |
| Family Psychologist | 103TF0000X | 83-07E-I | AR | |
| Group Psychotherapy Psychologist | 103TP2701X | 83-07E-I | AR | |
| School Psychologist | 103TS0200X | 83-07E-I | AR | Primary |
Addresses
Primary practice location
320 N Main St
Greenwood, AR 72936-7031
Mailing address
P. O. Box 3023
Greenwood, AR 72936-3020
Phone (479) 996-1414
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83-07E-I | AR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216598400000",
"number": "1750546693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P. O. BOX 3023",
"city": "GREENWOOD",
"state": "AR",
"postal_code": "729363020",
"telephone_number": "479-996-1414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 N MAIN ST",
"city": "GREENWOOD",
"state": "AR",
"postal_code": "729367031",
"telephone_number": "479-996-1414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MARY",
"middle_name": "KATHERINE",
"credential": "M.S.,LPE-I",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-21",
"last_updated": "2008-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AR",
"license": "83-07E-I",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "AR",
"license": "83-07E-I",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "AR",
"license": "83-07E-I",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "AR",
"license": "83-07E-I",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.