Healthcare Provider Details

I. General information

NPI: 1184633141
Provider Name (Legal Business Name): CLEAR PATHS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 SW COURT
DALLAS OR
97338
US

IV. Provider business mailing address

3793 RIVER RD N
KEIZER OR
97303-4827
US

V. Phone/Fax

Practice location:
  • Phone: 503-831-1423
  • Fax: 503-831-1573
Mailing address:
  • Phone: 503-304-7002
  • Fax: 503-304-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACCBO970482
License Number StateOR

VIII. Authorized Official

Name: TARA LA VINE
Title or Position: HUMAN RESOURCES GENERALIST
Credential:
Phone: 503-363-2021