Healthcare Provider Details

I. General information

NPI: 1619412160
Provider Name (Legal Business Name): NWI CLARITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 COLUMBIA AVE SUITE E2
MUNSTER IN
46321-3538
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 219-595-0043
  • Fax:
Mailing address:
  • Phone: 312-754-9404
  • Fax: 312-754-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANN-MARIE MICHELLE SANDS
Title or Position: CLINICAL DIRECTOR
Credential: LCSW, CADC
Phone: 312-754-9404