Provider Demographics
NPI: | 1669860672 |
---|---|
Name: | CLEARWATER COUNSELING |
Entity Type: | Organization |
Organization Name: | CLEARWATER COUNSELING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | CYNTHIA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | MCDOWELL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LIMHP |
Authorized Official - Phone: | 308-850-7190 |
Mailing Address - Street 1: | 4717 GUNBARREL PL |
Mailing Address - Street 2: | |
Mailing Address - City: | GRAND ISLAND |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68801-8504 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 308-850-7190 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4717 GUNBARREL PL |
Practice Address - Street 2: | |
Practice Address - City: | GRAND ISLAND |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68801-8504 |
Practice Address - Country: | US |
Practice Address - Phone: | 308-850-7190 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-12-26 |
Last Update Date: | 2014-12-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 1178 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |