Provider Demographics
NPI:1164607206
Name:CLEAR WINDS COUNSELING COUNSULTING GROUP, LLC
Entity Type:Organization
Organization Name:CLEAR WINDS COUNSELING COUNSULTING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERAC
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRUMM
Authorized Official - Suffix:
Authorized Official - Credentials:MA MHCT ADMIN
Authorized Official - Phone:509-939-7720
Mailing Address - Street 1:PO BOX 2294
Mailing Address - Street 2:116 N MAIN
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-2294
Mailing Address - Country:US
Mailing Address - Phone:509-939-7720
Mailing Address - Fax:509-276-2774
Practice Address - Street 1:116 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-2294
Practice Address - Country:US
Practice Address - Phone:509-939-7720
Practice Address - Fax:509-276-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)