Clearfork Cleburne LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

CLEARFORK CLEBURNE LLC

Practice address

1632 E FM 4
Cleburne, TX 76031-8861

Phone

(817) 259-2597

Fax

(817) 977-9507

NPI assigned

Nov 18, 2021

Last updated

Nov 18, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

CLEARFORK ACADEMY LPAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Austin Dale DavisNPI 1184906398

Title

Ceo

Phone

(817) 714-1311

Specialties & licenses 1

Addresses

Part of

Clearfork Academy

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Clearfork Academy LP

  • Substance Abuse Rehabilitation Facility
  • Fort Worth, TX
  • NPI 1558818534
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Austin Dale Davis, LPC

  • Counselor
  • Saginaw, TX
  • NPI 1184906398
  Authorized official Same address or phone
• Baqi S. Martin, LCSW

  • Clinical Social Worker
  • Fort Worth, TX
  • NPI 1487924775
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637193600000",
    "number": "1821755471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7820 HANGER CUTOFF RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761359560",
            "telephone_number": "817-259-2597",
            "fax_number": "817-977-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1632 E FM 4",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760318861",
            "telephone_number": "817-259-2597",
            "fax_number": "817-977-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARFORK CLEBURNE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLEARFORK ACADEMY LP",
        "enumeration_date": "2021-11-18",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-15",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "AUSTIN",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-714-1311"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Cleburne, TX
• Providers in Cleburne, TX by specialty
• Substance Abuse Rehabilitation Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.