Provider Demographics
NPI:1619350782
Name:CLEAR BROOK COUNSELING PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:CLEAR BROOK COUNSELING PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PFANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-292-3041
Mailing Address - Street 1:614 BILLY SUNDAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1525 AIRPORT RD STE 101
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8231
Practice Address - Country:US
Practice Address - Phone:515-292-3041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00800101YM0800X
IA00299101YM0800X
IA03167101YM0800X
IA076171041C0700X
IA079851041C0700X
IA00405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty