Renae Clark-Weatherly

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

99064493A Issued in IN

Legal business name

RENAE CLARK-WEATHERLY

Practice address

4126 E 10TH St
Indianapolis, IN 46201-2613

Phone

(317) 686-0931

Fax

(866) 406-5077

NPI assigned

Oct 5, 2017

Last updated

Sep 1, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Renae Clark-Weatherly, MA

Title

Therapist

Phone

(317) 222-9704

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1507161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725148800000",
    "number": "1275043069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5126 GUION RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462541725",
            "telephone_number": "317-222-9704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4126 E 10TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462012613",
            "telephone_number": "317-686-0931",
            "fax_number": "866-406-5077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAE CLARK-WEATHERLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-05",
        "last_updated": "2024-09-01",
        "certification_date": "2024-09-01",
        "status": "A",
        "authorized_official_last_name": "CLARK-WEATHERLY",
        "authorized_official_first_name": "RENAE",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "317-222-9704",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "IN",
            "license": "99064493A",
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IN",
            "license": "99074128A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Case Management Agency in Indianapolis, IN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2024; 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.