Provider Demographics
NPI:1558818534
Name:CLEARFORK ACADEMY LP
Entity Type:Organization
Organization Name:CLEARFORK ACADEMY LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-714-1311
Mailing Address - Street 1:7826 HANGER CUT OFF
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135
Mailing Address - Country:US
Mailing Address - Phone:817-714-1311
Mailing Address - Fax:
Practice Address - Street 1:7820 HANGER CUT OFF
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135
Practice Address - Country:US
Practice Address - Phone:817-714-1311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility