Provider Demographics
NPI:1598198152
Name:CLEARY, DARLA (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:
Last Name:CLEARY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:
Other - Last Name:DRENTLAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5868 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5868 BAKER RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-5903
Practice Address - Country:US
Practice Address - Phone:952-767-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200183101YM0800X
MN2146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health