Healthcare Provider Details

I. General information

NPI: 1750004602
Provider Name (Legal Business Name): CLEAN PROGRAMMING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W MARKET ST
LIMA OH
45801-4713
US

IV. Provider business mailing address

319 W MARKET ST
LIMA OH
45801-4713
US

V. Phone/Fax

Practice location:
  • Phone: 614-642-4700
  • Fax:
Mailing address:
  • Phone: 614-642-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO SMITH
Title or Position: CEO
Credential:
Phone: 614-642-4700