Active NPI
Mark A Clemons, PSY.D.
- Psychologist
- Athens, TX
National Provider Identifier
1871686501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 32132
- Practice address
- 506 Richardson St.
Athens, TX 75751-3430 - Phone
- (903) 677-4800
- Fax
- (903) 677-4803
- NPI assigned
- Oct 2, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 32132 | TX | Primary |
Addresses
Primary practice location
506 Richardson St.
Athens, TX 75751-3430
Mailing address
506 Richardson St.
Athens, TX 75751-3430
Phone (903) 677-4800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 165882501 | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32132 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214870400000",
"number": "1871686501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "506 RICHARDSON ST.",
"city": "ATHENS",
"state": "TX",
"postal_code": "757513430",
"telephone_number": "903-677-4800",
"fax_number": "903-677-4803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "506 RICHARDSON ST.",
"city": "ATHENS",
"state": "TX",
"postal_code": "757513430",
"telephone_number": "903-677-4800",
"fax_number": "903-677-4803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMONS",
"first_name": "MARK",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2008-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "32132",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "165882501",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Athens, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.