Clyde O Hanks, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

24895 Issued in TX

Practice address

1438 Marlene PL
Desoto, TX 75115-2907

Phone

(214) 850-6580

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Community Living Concepts, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Keene, TX
  • NPI 1316002439
  NPD (past)
• Rodom Medical Consulting PA

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1558380790
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1114945649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1438 MARLENE PL",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152907",
            "telephone_number": "214-850-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1438 MARLENE PL",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152907",
            "telephone_number": "214-850-6580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANKS",
        "first_name": "CLYDE",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "3853",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "24895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131884203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hamilton-Lucas Physicians PA
• Crystal Michelle Hamilton, RN
• Dorothea Rena Hamilton, CSA
• Sheba Vical Hamilton, LPC
• Hamilton'S Services, LLC
• Alec Markus Hanson, OD
• Hanus Chiropractic Clinic, P.a.
• Steven William Hanus, D.C.
• Dianna Harris, NP
• Kawanza Kamill Harris

• Clinical Psychologist in Desoto, TX
• Providers in Desoto, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; 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.