MEDICARE: CLEAR HORIZON THERAPY PLLC

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1912719485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR HORIZON THERAPY PLLC

Provider Business Mailing Address
First Line	:	5130 GOODWIN AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-6205
Country	:	US
Telephone Number	:	405-334-6533
Fax Number	:	214-594-8581

Provider Business Practice Location Address
First Line	:	5130 GOODWIN AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-6205
Country	:	US
Telephone Number	:	405-334-6533
Fax Number	:	214-594-8581

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. JONATHAN B WILSON
Credential	:	PHD, LMFT-S
Telephone Number	:	405-334-6533

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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