Provider Demographics
NPI:1518254119
Name:CLEARSKY COUNSELING LLC
Entity Type:Organization
Organization Name:CLEARSKY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-515-9391
Mailing Address - Street 1:1505 N PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-2580
Mailing Address - Country:US
Mailing Address - Phone:503-515-9391
Mailing Address - Fax:
Practice Address - Street 1:14511 WESTLAKE DR STE 102
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7783
Practice Address - Country:US
Practice Address - Phone:503-515-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-02
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL4100261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health