Provider Demographics
NPI:1821868464
Name:CLEAR PATH COUNSELING OF TN, LLC
Entity Type:Organization
Organization Name:CLEAR PATH COUNSELING OF TN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MADDUX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:423-794-7596
Mailing Address - Street 1:1131 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6379
Mailing Address - Country:US
Mailing Address - Phone:423-794-7596
Mailing Address - Fax:
Practice Address - Street 1:2306 KNOB CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2366
Practice Address - Country:US
Practice Address - Phone:423-794-7596
Practice Address - Fax:423-610-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty