Healthcare Provider Details

I. General information

NPI: 1457703373
Provider Name (Legal Business Name): CLEAR SKY BEHAVIORAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2016
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 RAILROAD ST
MARION NC
28752-5699
US

IV. Provider business mailing address

33 BURGIN ST STE D
MARION NC
28752-3903
US

V. Phone/Fax

Practice location:
  • Phone: 828-559-0346
  • Fax: 704-603-5986
Mailing address:
  • Phone: 828-559-2208
  • Fax: 704-603-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00542
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-059-072
License Number StateNC

VIII. Authorized Official

Name: MR. SCOTT MAURICE PRICE
Title or Position: MANAGING MEMBER
Credential:
Phone: 828-442-1396