Active NPI
Dan Clarkson
- Mental Health Counselor
- Mineola, TX
National Provider Identifier
1679540579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12420
- Practice address
- 703 W Patten St
Mineola, TX 75773-1541 - Phone
- (903) 569-5409
- NPI assigned
- Mar 1, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 12420 | TX | Primary |
Addresses
Primary practice location
703 W Patten St
Mineola, TX 75773-1541
Mailing address
PO Box 4730
Tyler, TX 75712-4730
Phone (903) 569-5409
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 027104102 | Medicaid | TX |
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 |
|---|---|---|---|
| 12420 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309219200000",
"number": "1679540579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4730",
"city": "TYLER",
"state": "TX",
"postal_code": "757124730",
"telephone_number": "903-569-5409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 W PATTEN ST",
"city": "MINEOLA",
"state": "TX",
"postal_code": "757731541",
"telephone_number": "903-569-5409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKSON",
"first_name": "DAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-01",
"last_updated": "2011-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "12420",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "027104102",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mineola, TX
- Erica L Campbell, PHARM.D.
- Brandi Diane Cerda
- Christus Trinity Clinic
- Christus Trinity Clinic Texas (Trinity Clinic Mineola)
- City of Ennis (Wood Memorial Nursing and Rehabilitation Center)
- Cindy Sue Cole, LVN
- Johnny Allen Colegrove, DC
- Taylor Renea Craver
- CVS Pharmacy Inc (CVS Pharmacy #10340)
- Henry Clay Davis, LICENSED PROFESSIONA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.