Healthcare Provider Details

I. General information

NPI: 1639705833
Provider Name (Legal Business Name): CLEAR SPACE SUPERVISION & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 AUTUMN LN
AKRON OH
44333-2101
US

IV. Provider business mailing address

1303 AUTUMN LN
AKRON OH
44333-2101
US

V. Phone/Fax

Practice location:
  • Phone: 330-289-2859
  • Fax:
Mailing address:
  • Phone: 330-289-2859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERIN E LANE-ORENTLIKHER
Title or Position: OWNER
Credential: LISW-S
Phone: 330-289-2859