Active NPI
Desda Clark, M.A., LPC
- Professional Counselor
- Parkville, MO
National Provider Identifier
1932413093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2008012808
- Practice address
- 8129 NW Walnut Way
Parkville, MO 64152-6103 - Phone
- (816) 510-6622
- NPI assigned
- Aug 1, 2010
- 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 | 2008012808 | MO | Primary |
Addresses
Primary practice location
8129 NW Walnut Way
Parkville, MO 64152-6103
Mailing address
8129 NW Walnut Way
Parkville, MO 64152-6103
Phone (816) 510-6622
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12132523 | Other | CAQH |
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 |
|---|---|---|---|
| 2008012808 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280620800000",
"number": "1932413093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8129 NW WALNUT WAY",
"city": "PARKVILLE",
"state": "MO",
"postal_code": "641526103",
"telephone_number": "816-510-6622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8129 NW WALNUT WAY",
"city": "PARKVILLE",
"state": "MO",
"postal_code": "641526103",
"telephone_number": "816-510-6622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DESDA",
"credential": "M.A., LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-01",
"last_updated": "2010-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2008012808",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "12132523",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Parkville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.