Healthcare Provider Details

I. General information

NPI: 1528878071
Provider Name (Legal Business Name): CLEAR MIND COACHING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 BURNT HEMLOCK RD
DU BOIS PA
15801-8745
US

IV. Provider business mailing address

146 BURNT HEMLOCK RD
DU BOIS PA
15801-8745
US

V. Phone/Fax

Practice location:
  • Phone: 626-755-8759
  • Fax:
Mailing address:
  • Phone: 626-755-8759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BRIDGMAN
Title or Position: MANAGING MEMBER
Credential: PH.D.
Phone: 626-755-8759