Provider Demographics
NPI:1275021560
Name:CLEAR FORK PSYCHOLOGY SERVICES, PLLC
Entity Type:Organization
Organization Name:CLEAR FORK PSYCHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-694-8916
Mailing Address - Street 1:4971 E INTERSTATE 20 SERVICE RD N
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3220
Mailing Address - Country:US
Mailing Address - Phone:817-694-8916
Mailing Address - Fax:682-224-5724
Practice Address - Street 1:4971 E INTERSTATE 20 SERVICE RD N
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3220
Practice Address - Country:US
Practice Address - Phone:817-694-8916
Practice Address - Fax:682-224-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty