Provider Demographics
NPI:1669861944
Name:KOURTNEY CLARK PLLC
Entity Type:Organization
Organization Name:KOURTNEY CLARK PLLC
Other - Org Name:DIAGNOSTIC SERVICES OF HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KOURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-512-1267
Mailing Address - Street 1:5420 DASHWOOD DR STE 310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5360
Mailing Address - Country:US
Mailing Address - Phone:713-512-1267
Mailing Address - Fax:713-512-1199
Practice Address - Street 1:5420 DASHWOOD DR STE 310
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5360
Practice Address - Country:US
Practice Address - Phone:713-512-1267
Practice Address - Fax:713-512-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80468237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty