Provider Demographics
NPI:1780647651
Name:CLARITY COUNSELING AND MEDIATION INC
Entity Type:Organization
Organization Name:CLARITY COUNSELING AND MEDIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:815-703-1001
Mailing Address - Street 1:483 N MULFORD RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5191
Mailing Address - Country:US
Mailing Address - Phone:815-520-2303
Mailing Address - Fax:815-977-5984
Practice Address - Street 1:483 N MULFORD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5191
Practice Address - Country:US
Practice Address - Phone:815-520-2303
Practice Address - Fax:815-977-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490094911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty