Cleanslate Medical Group of Texas PLLC

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

Legal business name

CLEANSLATE MEDICAL GROUP OF TEXAS PLLC

Practice address

2912 Kraft St Ste 30
Arlington, TX 76010-5410

Phone

(413) 584-2173

NPI assigned

Feb 9, 2017

Organization subpart

No

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

Authorized official

Name

Jessica Amick

Title

Director

Phone

(727) 798-8160

Specialties & licenses 4

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Cleanslate Medical Group of Indiana LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Alexandria, IN
  • NPI 1023464294

  Member Of

  NPD member

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lawrence Carter, LCDC

  • Addiction (Substance Use Disorder) Counselor
  • Arlington, TX
  • NPI 1831859701
  NPD
• Cathy Waldon Benavides, NP

  • Family Nurse Practitioner
  • San Antonio, TX
  • NPI 1821173832
  NPD (past)
• Vilma Benavides, FNP

  • Family Nurse Practitioner
  • San Antonio, TX
  • NPI 1215768759
  NPD (past)
• James Anthony Kelly, MD

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1447543087
  NPD (past)

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1487192522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 CADILLAC DR STE 180",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275393",
            "telephone_number": "154-250-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2912 KRAFT ST STE 30",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760105410",
            "telephone_number": "413-584-2173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEANSLATE MEDICAL GROUP OF TEXAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "AMICK",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "727-798-8160"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nadine Lucertia Clavo, LPC
• Ronald William Clawson, D.C.
• Sarah Claxton
• Clayton Dialysis LLC
• Thomas James Clayton, DDS
• Clearpath Hospice of Fort Worth, LLC
• Kiana Marie Clem, DO
• Dan E Clement, PHD
• William Clement, L.AC
• Melvin G Cleveland Jr., O.D.

• Addiction Medicine (Internal Medicine) Physician in Arlington, TX
• Providers in Arlington, TX by specialty
• Addiction Medicine (Internal Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; 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.