Provider Demographics
NPI:1356123517
Name:CLEAR MIND BEHAVIORAL
Entity type:Organization
Organization Name:CLEAR MIND BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCELENE
Authorized Official - Middle Name:CALVERT
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-857-3012
Mailing Address - Street 1:24 N TARRAGONA ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6063
Mailing Address - Country:US
Mailing Address - Phone:850-857-3012
Mailing Address - Fax:850-957-7001
Practice Address - Street 1:24 N TARRAGONA ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6063
Practice Address - Country:US
Practice Address - Phone:850-857-3012
Practice Address - Fax:850-957-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty