Active NPI
Ezell Clark, LCSW
- Clinical Social Worker
- North Richland Hills, TX
National Provider Identifier
1649002932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 63456
- Practice address
- 4925 Davis Blvd Ste No220
North Richland Hills, TX 76180-6875 - Phone
- (682) 777-5021
- NPI assigned
- Aug 15, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 Social Worker | 1041C0700X | 63456 | TX | Primary |
Addresses
Primary practice location
4925 Davis Blvd Ste No220
North Richland Hills, TX 76180-6875
Mailing address
7936 Arlie LN
North Richland Hills, TX 76182-8719
Phone (682) 777-5021
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63456 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723680000000",
"number": "1649002932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7936 ARLIE LN",
"city": "NORTH RICHLAND HILLS",
"state": "TX",
"postal_code": "761828719",
"telephone_number": "682-777-5021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4925 DAVIS BLVD STE NO220",
"city": "NORTH RICHLAND HILLS",
"state": "TX",
"postal_code": "761806875",
"telephone_number": "682-777-5021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "EZELL",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-08-15",
"last_updated": "2024-08-15",
"certification_date": "2024-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "63456",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Richland Hills, TX
- Mark Dwayne Christensen Sr., DDS
- City of North Richland Hills (North Richland Hills Fire Department)
- City Point Chiropractic, LLC
- Clarity Evaluators. LLC
- Clarity Neuropsychology, LLC
- Robyn A Clark, BCBA, LBA
- Classic Wellness Centers (DaVinci Medical Group)
- Clear Anesthesia PLLC
- Daniel Adam Clearfield, DO
- Maggie Kate Clemmons
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.