Provider Demographics
NPI:1609152198
Name:CLEAR PASSAGE COUNSELING
Entity Type:Organization
Organization Name:CLEAR PASSAGE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-786-8067
Mailing Address - Street 1:7671 OLD CENTRAL AVE NE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3575
Mailing Address - Country:US
Mailing Address - Phone:763-786-8067
Mailing Address - Fax:763-786-5080
Practice Address - Street 1:7671 OLD CENTRAL AVE NE
Practice Address - Street 2:SUITE 202
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3575
Practice Address - Country:US
Practice Address - Phone:763-786-8067
Practice Address - Fax:763-786-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty