Individual provider Active NPI

Clotie Wayland, LCSW

  • Clinical Social Worker
  • Houston, TX
National Provider Identifier
1174702302
Registry record updated Aug 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
16692 Issued in TX
Practice address
9525 Katy Fwy Ste 312
Houston, TX 77024-1467
Phone
(713) 343-2622
NPI assigned
Oct 24, 2007
Last updated
Aug 7, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 16692 TX Primary

Addresses

Primary practice location

9525 Katy Fwy Ste 312
Houston, TX 77024-1467

Mailing address

12431 Mardi Gras Dr
Houston, TX 77014-2484
Phone (832) 423-2708

Other identifiers 1

IdentifierTypeStateIssuer
124282805MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050622000233 TX Practitioner - Clinical Social Worker 6507829561 Reassigns benefits to 2 organizations
Practice locations: Houston, TX

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
BHC- Behavioral Health Consultants, IncGroup PAC ID 4587618319, 6 clinicians

Practice addresses (Care Compare)

9525 Katy Fwy
Suite 312
Houston, TX 77024-1467
Phone (713) 463-9449

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16692TXMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Stonebridge Structured Independent Living, Inc Clinical CurrentSince Aug 17, 2017 Accepting new patients
Restoration Odyssey Inc Past Accepting new patients
Story Healthcare Enterprises, LLC Clinical Past Accepting new patients

Locations

12218 Jones Rd
#D93
Houston, TX 77070

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249603200000",
    "number": "1174702302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12431 MARDI GRAS DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770142484",
            "telephone_number": "832-423-2708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9525 KATY FWY STE 312",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770241467",
            "telephone_number": "713-343-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAYLAND",
        "first_name": "CLOTIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-24",
        "last_updated": "2009-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "16692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124282805",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.