Kimberly Clough, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

59013 Issued in TX

Practice address

1010 Tristan LN
Longview, TX 75604-1862

Phone

(903) 918-6574

Fax

(903) 704-0980

NPI assigned

Aug 27, 2014

Last updated

Jun 17, 2024By the provider in NPPES

Sex

Female

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

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.clough.1@30520.direct.athenahealth.com

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.

• Sabine Valley Regional MHMR Center

  dba Community Healthcore

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Longview, TX
  • NPI 1639232002

  Clinical

  Medicare reassignment NPD
• Faithfully Restored

  dba Kimberly Clough

  • Clinical Social Worker
  • Longview, TX
  • NPI 1003323726
  NPD Authorized official
• Sabine Valley Regional MHMR Center

  dba Community Healthcore

  • Family Medicine Physician
  • Longview, TX
  • NPI 1841835022
  NPD

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

{
    "created_epoch": "1409097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1306246210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 JUDSON RD STE 182",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015199",
            "telephone_number": "903-309-0960",
            "fax_number": "903-309-1630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 TRISTAN LN",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756041862",
            "telephone_number": "903-918-6574",
            "fax_number": "903-704-0980"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 Webster St",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756025046",
            "country_code": "US",
            "telephone_number": "903-918-6574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLOUGH",
        "first_name": "KIMBERLY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-27",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TX",
            "license": "59013",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "59013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373636501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Clifton
• Clinnard LLC
• Clinton Ray Brunson, MD PA
• Angela Clipperton, RN
• George H Cloud Jr., DDS
• Christy Anne Cobb, FNP-C
• Codreaming LLC (The Body Mechanics)
• Lara Jane Coffey, LPC
• Kyle Bryce Coker, C.R.N.A
• Cole Counseling Center

• Clinical Social Worker in Longview, TX
• Providers in Longview, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.