Provider Demographics
NPI:1013588649
Name:CLN THERAPEUTIC SOLUTIONS
Entity Type:Organization
Organization Name:CLN THERAPEUTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-216-3365
Mailing Address - Street 1:956 FOREST RIDGE CT APT 202
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3376
Mailing Address - Country:US
Mailing Address - Phone:801-450-5704
Mailing Address - Fax:386-561-9974
Practice Address - Street 1:366 E GRAVES AVE STE D
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-5266
Practice Address - Country:US
Practice Address - Phone:801-450-5704
Practice Address - Fax:386-561-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty