Provider Demographics
NPI:1518569797
Name:CLARA HEALING INSTITUTE LLC
Entity Type:Organization
Organization Name:CLARA HEALING INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLEO
Authorized Official - Middle Name:
Authorized Official - Last Name:HONEYSUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-760-1961
Mailing Address - Street 1:3822 N 101ST ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7954 HARWOOD AVE STE 40
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2526
Practice Address - Country:US
Practice Address - Phone:414-573-6891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4145736891OtherTELEPHONE NUMBER