Provider Demographics
NPI:1659578599
Name:CLEAN AND CLEAR MINDED CCM COUNSELING LLC PC
Entity Type:Organization
Organization Name:CLEAN AND CLEAR MINDED CCM COUNSELING LLC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:MESSER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW CAC III
Authorized Official - Phone:303-638-8131
Mailing Address - Street 1:1827 QUAIL ST APT 9
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-2735
Mailing Address - Country:US
Mailing Address - Phone:303-638-8131
Mailing Address - Fax:720-222-8786
Practice Address - Street 1:9035 WADSWORTH PKWY
Practice Address - Street 2:SUITE #2750
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-8634
Practice Address - Country:US
Practice Address - Phone:303-638-8131
Practice Address - Fax:720-222-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5437101YA0400X
CO9899831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1114047172OtherINDIVIDUAL NPI NUMBER
CO$$$$$$$$$OtherSOCIAL SECURITY NUMBER