Provider Demographics
NPI:1619412160
Name:NWI CLARITY CLINIC
Entity Type:Organization
Organization Name:NWI CLARITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN-MARIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:312-754-9404
Mailing Address - Street 1:1 E SUPERIOR ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2507
Mailing Address - Country:US
Mailing Address - Phone:312-754-9404
Mailing Address - Fax:312-754-9402
Practice Address - Street 1:9250 COLUMBIA AVE
Practice Address - Street 2:SUITE E2
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3538
Practice Address - Country:US
Practice Address - Phone:219-595-0043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty