Healthcare Provider Details

I. General information

NPI: 1063803856
Provider Name (Legal Business Name): CLARITY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2015
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E SUPERIOR ST SUITE 306
CHICAGO IL
60611-2507
US

IV. Provider business mailing address

1 E SUPERIOR ST SUITE 306
CHICAGO IL
60611-2507
US

V. Phone/Fax

Practice location:
  • Phone: 312-754-9404
  • Fax: 312-754-9402
Mailing address:
  • Phone: 312-789-4532
  • Fax:

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PAVAN YARLAGADDARAGHU PRASAD
Title or Position: CEO
Credential: MD
Phone: 248-872-2400