Faithfully Restored

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

59013 Issued in TX

Legal business name

FAITHFULLY RESTORED

Practice address

1010 Tristan LN
Longview, TX 75604-1862

Phone

(903) 918-6574

Fax

(903) 704-0980

NPI assigned

Jan 3, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Clough, LCSWNPI 1306246210

Title

Ceo

Phone

(903) 918-6574

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kimberly Clough Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Clough, LCSW

  • Clinical Social Worker
  • Longview, TX
  • NPI 1306246210
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514937600000",
    "number": "1003323726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 TRISTAN LN",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756041862",
            "telephone_number": "903-918-6574",
            "fax_number": "903-704-0980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 TRISTAN LN",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756041862",
            "telephone_number": "903-918-6574",
            "fax_number": "903-704-0980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITHFULLY RESTORED",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2018-01-03",
        "status": "A",
        "authorized_official_last_name": "CLOUGH",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-918-6574",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "59013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373636801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kimberly Clough",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Social Worker in Longview, TX
• Providers in Longview, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.