Provider Demographics
NPI:1457703373
Name:CLEAR SKY BEHAVIORAL LLC
Entity Type:Organization
Organization Name:CLEAR SKY BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-442-1396
Mailing Address - Street 1:33 BURGIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-3903
Mailing Address - Country:US
Mailing Address - Phone:828-559-2208
Mailing Address - Fax:704-603-5986
Practice Address - Street 1:55 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5699
Practice Address - Country:US
Practice Address - Phone:828-559-0346
Practice Address - Fax:704-603-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-02
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005422084P0800X
NCMHL-059-072320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4011Medicaid