Active NPI
Katherine Whiteside Clark, M.A., L.P.C.
- Professional Counselor
- Birmingham, AL
National Provider Identifier
1881920866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2471
- Practice address
- 3104 Blue Lake Dr
Suite 100
Birmingham, AL 35243-2345 - Phone
- (205) 977-3003
- Fax
- (205) 977-3939
- NPI assigned
- Oct 26, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2471 | AL | Primary |
Addresses
Primary practice location
3104 Blue Lake Dr
Suite 100
Birmingham, AL 35243-2345
Mailing address
3104 Blue Lake Dr
Suite 100
Birmingham, AL 35243-2345
Phone (205) 977-3003
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2471 | AL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellspring Christian Clinic, Inc. | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Vestavia, AL
- NPI 1962526301
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256515200000",
"number": "1881920866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3104 BLUE LAKE DR",
"address_2": "SUITE 100",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352432345",
"telephone_number": "205-977-3003",
"fax_number": "205-977-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3104 BLUE LAKE DR",
"address_2": "SUITE 100",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352432345",
"telephone_number": "205-977-3003",
"fax_number": "205-977-3939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KATHERINE",
"middle_name": "WHITESIDE",
"name_prefix": "Mrs.",
"credential": "M.A., L.P.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-26",
"last_updated": "2009-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AL",
"license": "2471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.