Healthcare Provider Details

I. General information

NPI: 1740899491
Provider Name (Legal Business Name): CLEAR THE WAY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 09/02/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 DURHAM RD STE 13
MADISON CT
06443-2678
US

IV. Provider business mailing address

446 EVERGREEN AVE
HAMDEN CT
06518-2406
US

V. Phone/Fax

Practice location:
  • Phone: 860-575-8700
  • Fax:
Mailing address:
  • Phone: 860-575-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISBETH GANNON
Title or Position: OWNER
Credential: LPC
Phone: 860-575-8700