Provider Demographics
NPI:1013059179
Name:CLEAR MIND INC
Entity Type:Organization
Organization Name:CLEAR MIND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-331-2899
Mailing Address - Street 1:21851 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3976
Mailing Address - Country:US
Mailing Address - Phone:440-331-2899
Mailing Address - Fax:440-331-2899
Practice Address - Street 1:21851 CENTER RIDGE RD
Practice Address - Street 2:SUITE 411
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3976
Practice Address - Country:US
Practice Address - Phone:440-331-2899
Practice Address - Fax:440-331-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH83876101YA0400X
OHC1743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0208475Medicaid
OHCL9280371Medicare ID - Type Unspecified