KAITLYN MARY CLARK LPC
NPI 1457725095
Counselor - Professional in Tucker, GA

Q: What is Kaitlyn Clark's NPI number?

The NPI number for Kaitlyn Clark is 1457725095. It was assigned to this individual provider in the NPPES registry on November 19, 2015. The provider is also known as Kaitlyn Mary Bartfay Lpc.

Q: What is Kaitlyn Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Kaitlyn Clark was last updated on September 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 19, 2015PECOS Enrolled

3760 LAVISTA RD STE 102, TUCKER, GA 30084(770) 375-8124(770) 559-5543 Get Directions Write a Review

NPPES record last updated: September 6, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 6, 2022, Nov 8, 2021, Nov 19, 2015 (3 updates tracked since 2015).

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About Kaitlyn Mary Clark Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KAITLYN MARY CLARK LPC (NPI 1457725095) is an individual professional provider in Tucker, Georgia, licensed in Georgia (LPC012288) and active in the NPI registry since November 2015. She is enrolled in Medicare PECOS and maintains a secondary practice location in Atlanta.

NPPES Registry Identity

NPI1457725095

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameKAITLYN MARY CLARKCredential: LPC

Location Address3760 LAVISTA RD STE 102Tucker, GA 30084-5622

Mailing Address3760 Lavista Rd Ste 102Tucker, GA 30084-5622 · (770) 375-8124 · Fax (770) 559-5543

Phone(770) 375-8124

Fax(770) 559-5543

Sole ProprietorNo

Enumeration DateNovember 19, 2015

Last NPPES UpdateSeptember 6, 20223 updates tracked since enumeration

NPPES CertifiedSeptember 6, 2022

✔ NPI 1457725095 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in GA · LPC012288

Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X

3760 LAVISTA RD STE 102, Tucker, GA 30084

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Other Names 1

Former Name (1)Kaitlyn Mary Bartfay Lpc

Secondary Practice Location 1

Location 11370 Center Dr Ste 205Atlanta, GA 30338-4132 · Phone (770) 375-8124

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kaitlyn Mary Clark Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CAMERON GRACE HOM

Psychologist