Clarence Austin Church III, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CTL0222201 Issued in NM

Practice address

2901 E 20TH St
Farmington, NM 87402-4411

Phone

(505) 326-0241

NPI assigned

Apr 11, 2022

Last updated

Apr 11, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Alii Health CenterGroup PAC ID 4486984549, 50 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alii Health Center

  • Multi-Specialty Clinic/Center
  • Kailua Kona, HI
  • NPI 1285107698

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Kuokoa Counseling, LLC

  • Mental Health Counselor
  • Pahoa, HI
  • NPI 1063260628
  NPD Authorized official
• Ali'I Health Center

  dba Ali'i Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Kailua Kona, HI
  • NPI 1144949967
  NPD
• Alii Health Center

  • Urology Physician
  • Kailua Kona, HI
  • NPI 1225620321
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1871235655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 ROAD 3900",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874013203",
            "telephone_number": "719-502-1366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 E 20TH ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874024411",
            "telephone_number": "505-326-0241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "CLARENCE",
        "middle_name": "AUSTIN",
        "name_suffix": "III",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CTL0222201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank Charles Chovan, CPO
• Barbara Maurer Christensen, RPT
• Joshua Mark Christensen, PHARMD
• Nathanael Cook Christensen, DO
• Tyson Christensen, M.D.
• Clay Church, NP
• Maria L Cisneros, LCSW
• Clarity Counseling P.C.
• Candice Ella Clark, DDS
• Daniel Dee Clark, D.D.S.

• Mental Health Counselor in Farmington, NM
• Providers in Farmington, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.