Provider Demographics
NPI:1366844078
Name:CLEARVIEW GUIDANCE CENTER
Entity Type:Organization
Organization Name:CLEARVIEW GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-307-3987
Mailing Address - Street 1:15541 FLYBOAT LN
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6021
Mailing Address - Country:US
Mailing Address - Phone:651-307-3987
Mailing Address - Fax:
Practice Address - Street 1:2817 ANTHONY LN S STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-2490
Practice Address - Country:US
Practice Address - Phone:651-307-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21047251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health