Provider Demographics
NPI:1376092643
Name:CLEAR MOUNTAIN THERAPY LLC
Entity Type:Organization
Organization Name:CLEAR MOUNTAIN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-631-2180
Mailing Address - Street 1:1250 EXECUTIVE PL
Mailing Address - Street 2:SUITE 404
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3807
Mailing Address - Country:US
Mailing Address - Phone:630-631-2180
Mailing Address - Fax:630-578-0226
Practice Address - Street 1:1250 EXECUTIVE PL
Practice Address - Street 2:SUITE 404
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3807
Practice Address - Country:US
Practice Address - Phone:630-631-2180
Practice Address - Fax:630-578-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006406251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health