Active NPI
Hayley Blackwood, PH.D.
- Clinical Psychologist
- Fort Worth, TX
National Provider Identifier
1689115438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 36848
- Practice address
- 15833 Bent Rose Way
Fort Worth, TX 76177 - Phone
- (256) 531-6658
- NPI assigned
- Mar 13, 2017
- Last updated
- Mar 13, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 36848 | TX | Primary |
Addresses
Primary practice location
15833 Bent Rose Way
Fort Worth, TX 76177
Mailing address
15833 Bent Rose Way
Fort Worth, TX 76177
Phone (256) 531-6658
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170802001221 | TX | Practitioner - Clinical Psychologist | 2668743196 | Practice locations: Willow Park, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4971 E I-20 Service Rd N
Clearfork Psychology Building
Willow Park, TX 76087-3220
Phone (256) 531-6658
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36848 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489363200000",
"number": "1689115438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15833 BENT ROSE WAY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76177",
"telephone_number": "256-531-6658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15833 BENT ROSE WAY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76177",
"telephone_number": "256-531-6658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWOOD",
"first_name": "HAYLEY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-13",
"last_updated": "2017-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "36848",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.