Active NPI
Brandon C Clark
- Counselor
- Deerfield Beach, FL
National Provider Identifier
1871872416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 103K00000X
- Practice address
- 500 Fairway Dr
Deerfield Beach, FL 33441-1814 - Phone
- (954) 603-7885
- NPI assigned
- Aug 14, 2011
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 103K00000X | FL | Primary |
Addresses
Primary practice location
500 Fairway Dr
Deerfield Beach, FL 33441-1814
Mailing address
6 Roseberry Cir
Port Wentworth, GA 31407-5612
Phone (850) 567-5657
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 |
|---|---|---|---|
| 103K00000X | FL | MD | Community/Behavioral Health Agency |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Progressive Behavior Consulting LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Port Wentworth, GA
- NPI 1780063651
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420156800000",
"number": "1871872416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 ROSEBERRY CIR",
"city": "PORT WENTWORTH",
"state": "GA",
"postal_code": "314075612",
"telephone_number": "850-567-5657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 FAIRWAY DR",
"city": "DEERFIELD BEACH",
"state": "FL",
"postal_code": "334411814",
"telephone_number": "954-603-7885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BRANDON",
"middle_name": "C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-14",
"last_updated": "2015-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "FL",
"license": "103K00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deerfield Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.