Provider Demographics
NPI: | 1427839414 |
---|---|
Name: | CLEAR MINDSET COUNSELING CENTER, INC. |
Entity type: | Organization |
Organization Name: | CLEAR MINDSET COUNSELING CENTER, INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | VP |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TRACY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MORIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, LCSW |
Authorized Official - Phone: | 321-677-6463 |
Mailing Address - Street 1: | 675 ATZ RD |
Mailing Address - Street 2: | |
Mailing Address - City: | MALABAR |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32950-3628 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 321-298-2376 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5423 VILLAGE DR |
Practice Address - Street 2: | |
Practice Address - City: | ROCKLEDGE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32955-6570 |
Practice Address - Country: | US |
Practice Address - Phone: | 321-298-2376 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-10-06 |
Last Update Date: | 2024-01-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | Group - Multi-Specialty | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |