Active NPI
Lisa L Clark, PH.D.
- Clinical Psychologist
- Cordova, TN
National Provider Identifier
1396754370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- HSP-1188
- Practice address
- 8134 Country Village Dr
#102
Cordova, TN 38016 - Phone
- (901) 756-8398
- Fax
- (901) 756-8701
- NPI assigned
- Aug 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | HSP-1188 | TN | Primary |
Addresses
Primary practice location
8134 Country Village Dr
#102
Cordova, TN 38016
Mailing address
PO Box 341065
Memphis, TN 38184-1065
Phone (901) 385-2342
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3682232 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HSP-1188 | TN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396754370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 341065",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381841065",
"telephone_number": "901-385-2342",
"fax_number": "901-382-0140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8134 COUNTRY VILLAGE DR",
"address_2": "#102",
"city": "CORDOVA",
"state": "TN",
"postal_code": "38016",
"telephone_number": "901-756-8398",
"fax_number": "901-756-8701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LISA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "HSP-1188",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3682232",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.