Healthcare Provider Details

I. General information

NPI: 1235066945
Provider Name (Legal Business Name): CLEARLANE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 E FOWLER AVE # 601
TAMPA FL
33612-6297
US

IV. Provider business mailing address

2780 E FOWLER AVE # 601
TAMPA FL
33612-6297
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-2276
  • Fax: 614-412-2522
Mailing address:
  • Phone: 813-444-2276
  • Fax: 614-412-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY WILDER-WHITING
Title or Position: NURSE PRACTITIONER/OWNER
Credential: APRN, FNP-C, PMHNP-C
Phone: 813-444-2276