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Alec Cole Clark

Individual provider Active NPI Behavior Technician · Dade City, FL

NPI 1003511072 · NPPES record last updated Sep 17, 2025

Key facts

NPI
1003511072
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
15048 14TH St
Dade City, FL 33523-2503
Phone
(352) 232-8997
Fax
(833) 422-0029
NPI assigned
Mar 31, 2023
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
T-5055MSMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Behavioral Solutions LLC Behavior Technician Current
since Sep 21, 2025		 Accepting new patients

Locations

15048 14th St
Dade City, FL 33523
Phone (352) 232-8997

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GFAFAD/Endpoint/GFAFAD

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X T-5055 MS
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

15048 14TH St
Dade City, FL 33523-2503

Mailing address

15048 14TH St
Dade City, FL 33523-2503
Phone (352) 232-8997

Other providers in Dade City, FL

All providers in Dade City, FL · Behavior Technician in Florida

Sources for this page

Verify at the official NPI Registry.