Active NPI
Latrece Clark
- Psychologist
- Arlington, TX
National Provider Identifier
1114595246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 70305
- Practice address
- 6043 W Interstate 20
Arlington, TX 76017-1042 - Phone
- (817) 533-0825
- Fax
- (817) 953-8899
- NPI assigned
- Jun 15, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 70305 | TX | Primary |
Addresses
Primary practice location
6043 W Interstate 20
Arlington, TX 76017-1042
Mailing address
6043 W Interstate 20
Arlington, TX 76017-1042
Phone (817) 533-0825
Other names 1
- Latrece Ferguson-Clark
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70305 | TX | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623715200000",
"number": "1114595246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6043 W INTERSTATE 20",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760171042",
"telephone_number": "817-533-0825",
"fax_number": "817-953-8899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6043 W INTERSTATE 20",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760171042",
"telephone_number": "817-533-0825",
"fax_number": "817-953-8899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LATRECE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-15",
"last_updated": "2021-06-15",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "70305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LATRECE",
"last_name": "FERGUSON-CLARK",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Arlington, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.