Healthcare Provider Details

I. General information

NPI: 1174219448
Provider Name (Legal Business Name): CLARITY OF MIND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 DIAGONAL ST
CLARKSTON WA
99403-2041
US

IV. Provider business mailing address

601 3RD ST PMB 374
CLARKSTON WA
99403
US

V. Phone/Fax

Practice location:
  • Phone: 208-553-5073
  • Fax:
Mailing address:
  • Phone: 208-553-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALLISON COLE
Title or Position: OWNER
Credential: LICSWA, LMSW
Phone: 208-553-5073