Provider Demographics
NPI:1164057436
Name:CLEAR REFLECTIONS PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:CLEAR REFLECTIONS PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:BRENISER
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:517-414-0065
Mailing Address - Street 1:124 NICOLE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-9379
Mailing Address - Country:US
Mailing Address - Phone:517-414-0065
Mailing Address - Fax:
Practice Address - Street 1:225 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-9158
Practice Address - Country:US
Practice Address - Phone:517-414-0065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty