Provider Demographics
NPI:1841160728
Name:CLEAR MIND WELLNESS GROUP LLC
Entity type:Organization
Organization Name:CLEAR MIND WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:
Authorized Official - Last Name:IREDIA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-PMHNP-BC
Authorized Official - Phone:862-224-5279
Mailing Address - Street 1:23 WOOD THRUSH AVE
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5275
Mailing Address - Country:US
Mailing Address - Phone:848-304-1631
Mailing Address - Fax:
Practice Address - Street 1:23 WOOD THRUSH AVE
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5275
Practice Address - Country:US
Practice Address - Phone:848-304-1631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-06
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health