Lecretia Williams Clark, M.ED, LPC
Individual provider Active NPI Mental Health Counselor · Hernando, MS
NPI 1821484494 · NPPES record last updated Sep 2, 2016
Key facts
- NPI
- 1821484494
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 3389 (MS)
- Practice address
- 2705 Highway 51 S
Hernando, MS 38632-2634 - Phone
- (662) 449-1971
- Fax
- (662) 449-1974
- NPI assigned
- Apr 10, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240722001875 | MS | Practitioner - Mental Health Counselor | 2567811656 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3389 | MS | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Right Track Medical Group, Inc | Current |
Accepting new patients | |
| Region IV Mental Health Services | Past | Accepting new patients | |
| Precise Clinical Neuroscience Specialists | Past | Accepting new patients | |
| Region IV Mental Health Services | Past | Accepting new patients |
Locations
9035 E Sandidge Rd
Ste 201
Olive Branch, MS 38654
Phone (662) 408-4631
200 Highway 12 E
Starkville, MS 39759
Phone (662) 498-1900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3389 | MS | Yes |
Addresses
Primary practice location
2705 Highway 51 S
Hernando, MS 38632-2634
Mailing address
303 N Madison St
Corinth, MS 38834-5072
Phone (662) 286-9883
Other providers in Hernando, MS
- Cormelanie Shondell Chillous
- Eu Gene Chin
- Sushma Chowdhary
- Yashwant M Chowdhary
- City of Hernando Ambulance
- William Clark0
- Paula Clay
- D'Allegra Cochran
- Wendy Gail Collums
- Community Dental Care,PA
All providers in Hernando, MS · Mental Health Counselor in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.