Clear Lake Behavioral Health LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

CLEAR LAKE BEHAVIORAL HEALTH LLC

Practice address

3817 Ledgestone CT
Richardson, TX 75082-2775

Phone

(630) 405-8975

NPI assigned

Apr 3, 2024

Organization subpart

No

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

Authorized official

Name

Aya Kassar

Title

Manager

Phone

(630) 405-8975

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1457103418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3817 LEDGESTONE CT",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822775",
            "telephone_number": "630-405-8975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3817 LEDGESTONE CT",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822775",
            "telephone_number": "630-405-8975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR LAKE BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "KASSAR",
        "authorized_official_first_name": "AYA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "630-405-8975"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Richardson, TX
• Providers in Richardson, TX by specialty
• Behavior Analyst in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.