Healthcare Provider Details

I. General information

NPI: 1235615774
Provider Name (Legal Business Name): AIREAL PATRICE CLINTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 COMMERCE DR.
PERRYSBURG OH
43551
US

IV. Provider business mailing address

855 COMMERCE DR.
PERRYSBURG OH
43551
US

V. Phone/Fax

Practice location:
  • Phone: 419-419-3829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608469
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: