Stanley D Clark Jr., PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2119 Issued in TN

Practice address

2106 Treasure Hills Blvd
Harlingen, TX 78550-8736

Phone

(956) 366-4500

Fax

(956) 366-4501

NPI assigned

Nov 29, 2006

Last updated

Mar 21, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458518400000",
    "number": "1356418966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 TREASURE HILLS BLVD",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785508736",
            "telephone_number": "956-366-4500",
            "fax_number": "956-366-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 TREASURE HILLS BLVD",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785508736",
            "telephone_number": "956-366-4500",
            "fax_number": "956-366-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STANLEY",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2016-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "2119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN HEALTH",
            "identifier": "169996000",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "3094668",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7838192",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Cisneros
• Laura E Cisneros, MD
• Michael Anthony Cisneros Jr.
• Sharon Cisneros, RN
• Nancy Clark, PHARM.D.
• Bryan David Clarke, PSYD
• Teresa Diane Clarkston, LVN
• Claudia Perez (Vitalis Wellness & Medspa)
• Claudia R. Jensen , Aprn, FNP-BC, PLLC (Jensen Family Clinic)
• Reynaldo Cleto, LVN

• Psychologist in Harlingen, TX
• Providers in Harlingen, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2016; 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.