Healthcare Provider Details

I. General information

NPI: 1508696071
Provider Name (Legal Business Name): COMPLETE CLARITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21700 NORTHWESTERN HWY STE 860
SOUTHFIELD MI
48075-4911
US

IV. Provider business mailing address

25523 FRIAR LN
SOUTHFIELD MI
48033-2770
US

V. Phone/Fax

Practice location:
  • Phone: 313-970-8254
  • Fax:
Mailing address:
  • Phone: 313-671-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MAYA COBB
Title or Position: OWNER
Credential:
Phone: 313-727-1593