NPI Code Detail JSON Logo

1528725660 NPI number — ELLEN ESTELLE CLARK LCDC

NPI Number: 1528725660
Health Care Provider/Practitioner: ELLEN ESTELLE CLARK LCDC

Information about “1528725660” NPI (ELLEN ESTELLE CLARK LCDC) exists in 1528725660 in HTML format HTML  |  1528725660 in plain Text format TXT  |  1528725660 in PDF (Portable Document Format) PDF  |  1528725660 in an XML format XML  formats.

NPI Number : 1528725660 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528725660",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLARK",
    "FirstName": "ELLEN",
    "MiddleName": "ESTELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCDC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CLARK",
    "OtherFirstName": "ELLEN",
    "OtherMiddleName": "E",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCDC III, CCMI-M",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "200 LOWRIE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HENDERSON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75652-3308",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "430-280-4432",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1700 POST OAK BLVD STE 600",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77056-3973",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "800-892-2695",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/23/2021",
    "LastUpdateDate": "01/10/2024",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "12293",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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