Active NPI
Timothy Scott Clark, PHD
- Clinical Neuropsychologist
- Richardson, TX
National Provider Identifier
1669513545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 24179
- Practice address
- 600 W Campbell Rd
Suite 2
Richardson, TX 75080-3357 - Phone
- (214) 392-9951
- Fax
- (928) 441-7305
- NPI assigned
- Feb 12, 2007
- 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 Neuropsychologist | 103G00000X | 24179 | TX | Primary |
Addresses
Primary practice location
600 W Campbell Rd
Suite 2
Richardson, TX 75080-3357
Mailing address
2815 Canyon Valley TRL
Plano, TX 75075-2903
Phone (214) 392-9951
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 |
|---|---|---|---|
| 24179 | TX | MD | Dentist |
Interoperability endpoints
- tclark456598@direct.sw.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669513545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2815 CANYON VALLEY TRL",
"city": "PLANO",
"state": "TX",
"postal_code": "750752903",
"telephone_number": "214-392-9951",
"fax_number": "928-441-7305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 W CAMPBELL RD",
"address_2": "SUITE 2",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750803357",
"telephone_number": "214-392-9951",
"fax_number": "928-441-7305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TIMOTHY",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "TX",
"license": "24179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richardson, TX
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.