Provider Demographics
NPI:1780224287
Name:CLEARMAN, THEODORE JACK (LCPC)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:JACK
Last Name:CLEARMAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 REEDERS ALY
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-6286
Mailing Address - Country:US
Mailing Address - Phone:406-422-9448
Mailing Address - Fax:
Practice Address - Street 1:113 REEDERS ALY
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-6286
Practice Address - Country:US
Practice Address - Phone:406-422-9448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-37853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional