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1679054498 NPI number — KATE LYNN MATTHEWS CLARK LCPC-C

NPI Number: 1679054498
Health Care Provider/Practitioner: KATE LYNN MATTHEWS CLARK LCPC-C

Information about “1679054498” NPI (KATE LYNN MATTHEWS CLARK LCPC-C) exists in 1679054498 in HTML format HTML  |  1679054498 in plain Text format TXT  |  1679054498 in PDF (Portable Document Format) PDF  |  1679054498 in an XML format XML  formats.

NPI Number : 1679054498 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679054498",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLARK",
    "FirstName": "KATE",
    "MiddleName": "LYNN MATTHEWS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCPC-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MATTHEWS",
    "OtherFirstName": "KATE",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "12 GENTLE BREEZE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINDHAM",
    "MailingAddressStateName": "ME",
    "MailingAddressPostalCode": "04062-7004",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "207-491-9301",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7 OAK HILL TER STE 211",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SCARBOROUGH",
    "PracticeLocationAddressStateName": "ME",
    "PracticeLocationAddressPostalCode": "04074-8996",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "207-491-9301",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/29/2018",
    "LastUpdateDate": "05/06/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "XL5100",
        "LicenseNumberStateCode": "ME",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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