MEDICARE: DARLA CLEARY MA, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C.1200183	OH
2	101YP2500X	Professional Counselor	2146	MN

General Provider Information

NPI Number	:	1598198152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLA CLEARY MA, LPCC

Provider Business Mailing Address
First Line	:	5868 BAKER RD
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-5903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5868 BAKER RD
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-5903
Country	:	US
Telephone Number	:	952-767-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2013
Last Update Date	:	06/06/2019

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