Active NPI
Kearston L Clark, ALC
- Mental Health Counselor
- Auburn, AL
National Provider Identifier
1962116517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 3764
- Practice address
- 2431 E Glenn Ave Ste 400
Auburn, AL 36830-6504 - Phone
- (334) 275-7440
- NPI assigned
- Jan 9, 2023
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3764 | AL | Primary |
Addresses
Primary practice location
2431 E Glenn Ave Ste 400
Auburn, AL 36830-6504
Mailing address
2431 E Glenn Ave Ste 400
Auburn, AL 36830-6504
Phone (334) 275-7440
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 |
|---|---|---|---|
| 3764 | AL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673222400000",
"number": "1962116517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2431 E GLENN AVE STE 400",
"city": "AUBURN",
"state": "AL",
"postal_code": "368306504",
"telephone_number": "334-275-7440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2431 E GLENN AVE STE 400",
"city": "AUBURN",
"state": "AL",
"postal_code": "368306504",
"telephone_number": "334-275-7440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KEARSTON",
"middle_name": "L",
"credential": "ALC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-09",
"last_updated": "2023-01-09",
"certification_date": "2023-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AL",
"license": "3764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.