Provider Demographics
NPI:1508302654
Name:CLARITY MENTAL WELLNESS CENTER
Entity Type:Organization
Organization Name:CLARITY MENTAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW/LCSW
Authorized Official - Phone:689-710-3276
Mailing Address - Street 1:12472 LAKE UNDERHILL RD STE 514
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7144
Mailing Address - Country:US
Mailing Address - Phone:689-710-3276
Mailing Address - Fax:
Practice Address - Street 1:12472 LAKE UNDERHILL RD STE 514
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7144
Practice Address - Country:US
Practice Address - Phone:689-710-3276
Practice Address - Fax:855-944-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079597251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health