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Contact Information

MICHAEL CLARK
1107 LAVENDER SHADE COURT
HOUSTON, TX77073
 Phone: 817-707-4440
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Mental Health

101YM0800X
Indicates primary specialty

NPI Profile & details for MICHAEL CLARK · (Male)

NPI # 1215534227
Status Active
Credentials
Entity Individual
Enumeration date 10/02/2020
Last updated 10/10/2025 - About 8 months ago
Sole proprietor 1 Yes
Identifiers
  • TX License # 18841841
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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