GREGORY SCOTT CLARK JR. (NPI# 1881055911) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881055911 |
| Entity Type | Individual |
| Full Name | GREGORY SCOTT CLARK JR. |
| Practice Address |
1121 E Southeast Loop 323 Ste 204 Tyler TX 75701 |
| Mailing Address |
1121 E Southeast Loop 323 Ste 204 Tyler TX 75701-9660 |
| Practice Telephone | 9035810933 |
| Practice Fax Number | 9035810933 |
| Mailing Telephone | 9035810933 |
| Mailing Fax Number | 9035810933 |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2019-10-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
31769 | TX | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
78242 | TX | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 13207 Wright Rd, Buda, TX 78610 | 5126978600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760991012 | Gregory Clark | Driver | 1091 Old South Dr, Lakeland, FL 33811 | 2017-09-28 |
| 1184758229 | Gregory Ray Clark | Physical Therapist | 3 Windsor Ct, Shawnee, OK 74804-2330 | 2007-03-14 |
| 1114064797 | Gregory Dale Clark | Dentist | 4212 Mcever Rd, Oakwood, GA 30566-2237 | 2007-01-31 |
| 1225141823 | Gregory Lynn Clark | Specialist | 11790 Sw Barnes Rd, Suite 330, Portland, OR 97225-5934 | 2006-08-16 |
| 1689608952 | Gregory D Clark | Social Worker | 118 Broadway N, Ste 810, Fargo, ND 58102-4949 | 2006-07-10 |
| 1164409728 | Gregory Clark | Counselor | 225 N Beaumont Rd, Prairie Du Chien, WI 53821-1445 | 2005-12-26 |
| 1528627833 | Gregory Scott Clark | Nurse Anesthetist, Certified Registered | 3333 W Deyoung St, Marion, IL 62959-5884 | 2019-06-10 |
| 1073178851 | Gregory Clark | Student in an Organized Health Care Education/Training Program | 550 1st Ave, New York, NY 10016-6402 | 2019-05-07 |
| 1548736622 | Gregory Allen Clark | Marriage & Family Therapist | 1150 5th St Ste 270, Coralville, IA 52241-2933 | 2018-10-16 |
| 1164841102 | Gregory S Clark | Physician Assistant | 8433 Harcourt Rd Ste 100, Indianapolis, IN 46260-2193 | 2014-04-07 |
| Street Address |
1121 E SOUTHEAST LOOP 323 STE 204 |
| City | TYLER |
| State | TX |
| Zip Code | 75701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962842237 | Jaclyn Nicole Abell | Counselor | 1121 E Southeast Loop 323 Ste 204, Tyler, TX 75701 | 2013-07-01 |
| 1598306581 | Ron L. Roberts, M.s., P.C. | Psychologist | 1121 E Southeast Loop 323 Ste 204, Tyler, TX 75701-9660 | 2019-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023622164 | Tere Pamela Ortega | Counselor | 701 Shiloh Rd Apt 717, Tyler, TX 75703-3838 | 2020-09-05 |
| 1669083937 | Arturo Vega II | Counselor | 5000 Edinburgh Dr Apt 904, Tyler, TX 75703-2713 | 2020-08-11 |
| 1063020675 | Tyler Family Counseling, Pllc | Counselor | 16075 Fm 2493, Tyler, TX 75703-7363 | 2020-07-20 |
| 1144838707 | Ceselie Ann Tobin | Counselor | 121 S Broadway Ave Ste 820, Tyler, TX 75702-7282 | 2020-07-20 |
| 1124636824 | Austyn Teal Bailiff | Counselor | 1058 Asher Way Ste 400, Tyler, TX 75703-6076 | 2020-07-19 |
| 1881237899 | Ida F Baty | Counselor | 3367 Cascades Blvd Apt 119, Tyler, TX 75709-5447 | 2019-10-22 |
| 1073077673 | Hobert Stanley Miller | Counselor | 15360 Fm 850, Tyler, TX 75707-3916 | 2019-01-28 |
| 1922594308 | Grace Counceling Center | Counselor | 1828 E Se Loop 323 Ste Ll14, Tyler, TX 75701-8398 | 2018-07-09 |
| 1578072971 | Julie Kathryn David | Counselor | 17121 Us Highway 69 S, Tyler, TX 75703-8091 | 2017-09-28 |
| 1619411204 | Marla Cannefax | Counselor | 121 S Broadway Ave Ste 528, Tyler, TX 75702-7209 | 2016-12-15 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.