Active NPI
Cory J Clark, LPC, LCDC, LMFTA
- Professional Counselor
- Austin, TX
National Provider Identifier
1780003574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 67615
- Practice address
- 403 E 15TH St
Austin, TX 78701-1437 - Phone
- (512) 480-0920
- NPI assigned
- Apr 9, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11614 | TX | |
| Professional Counselor | 101YP2500X | 67615 | TX | Primary |
Addresses
Primary practice location
403 E 15TH St
Austin, TX 78701-1437
Mailing address
1430 Collier St
Austin, TX 78704-2911
Phone (512) 472-4357
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 |
|---|---|---|---|
| 11614 | TX | MD | Addiction (Substance Use Disorder) Counselor |
| 67615 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Austin Travis County Mental Health and Mental Retardation Center | Past | Accepting new patients | |
| Austin Travis County Mental Health and Mental Retardation Center | Professional | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Austin, TX
- NPI 1053632505
-
- Psychiatry Physician
- Austin, TX
- NPI 1750337259
Professional
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397001600000",
"number": "1780003574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1430 COLLIER ST",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787042911",
"telephone_number": "512-472-4357",
"fax_number": "512-703-1394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 E 15TH ST",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787011437",
"telephone_number": "512-480-0920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CORY",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "LPC, LCDC, LMFTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-04-09",
"last_updated": "2014-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "11614",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "67615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.