Active NPI
Kirby Kay Lajett Clark, MPC
- Mental Health Counselor
- Ballston Spa, NY
National Provider Identifier
1962004887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- P104773
- Practice address
- 76 Springwood Meadows Dr
Ballston Spa, NY 12020-3541 - Phone
- (316) 706-3275
- NPI assigned
- Nov 16, 2020
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P104773 | NY | Primary |
Addresses
Primary practice location
76 Springwood Meadows Dr
Ballston Spa, NY 12020-3541
Mailing address
2452 Route 9, Suite 302
Malta, NY 12020
Phone (316) 706-3275
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P104773 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605484800000",
"number": "1962004887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2452 ROUTE 9, SUITE 302",
"city": "MALTA",
"state": "NY",
"postal_code": "12020",
"telephone_number": "316-706-3275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 SPRINGWOOD MEADOWS DR",
"city": "BALLSTON SPA",
"state": "NY",
"postal_code": "120203541",
"telephone_number": "316-706-3275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KIRBY KAY",
"middle_name": "LAJETT",
"credential": "MPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-16",
"last_updated": "2020-11-16",
"certification_date": "2020-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "P104773",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ballston Spa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.