Provider Demographics
NPI:1356196729
Name:CLEAR WATERS COUNSELING
Entity type:Organization
Organization Name:CLEAR WATERS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:LSWC-C
Authorized Official - Phone:240-332-0797
Mailing Address - Street 1:11217 MAPLEVILLE RD APT B
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-1801
Mailing Address - Country:US
Mailing Address - Phone:240-382-0169
Mailing Address - Fax:240-666-8506
Practice Address - Street 1:9093 RIDGEFIELD DR STE 206
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6712
Practice Address - Country:US
Practice Address - Phone:240-332-0797
Practice Address - Fax:240-666-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty