Provider Demographics
NPI:1013471812
Name:CLARITY PTH LLC
Entity type:Organization
Organization Name:CLARITY PTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-546-3714
Mailing Address - Street 1:1150 HILLSBORO MILE APT 407
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1731
Mailing Address - Country:US
Mailing Address - Phone:954-299-8951
Mailing Address - Fax:
Practice Address - Street 1:10400 GRIFFIN RD STE 101
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3320
Practice Address - Country:US
Practice Address - Phone:954-299-8951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty