Provider Demographics
NPI:1326707753
Name:CLARITY MIND & MEMORY CLINIC PLLC
Entity Type:Organization
Organization Name:CLARITY MIND & MEMORY CLINIC PLLC
Other - Org Name:CLARITY MIND & MEMORY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORINNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GLATT
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP-BC
Authorized Official - Phone:701-426-5664
Mailing Address - Street 1:3100 N 11TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1210
Mailing Address - Country:US
Mailing Address - Phone:701-712-0066
Mailing Address - Fax:701-712-0077
Practice Address - Street 1:3100 N 11TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1210
Practice Address - Country:US
Practice Address - Phone:701-426-5664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty