Healthcare Provider Details

I. General information

NPI: 1851926992
Provider Name (Legal Business Name): CLEAR MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 BRIDGEPORT WAY W STE F
UNIVERSITY PLACE WA
98466-4724
US

IV. Provider business mailing address

9000 CROW CANYON RD STE S360
DANVILLE CA
94506-1189
US

V. Phone/Fax

Practice location:
  • Phone: 253-666-6780
  • Fax: 253-666-6793
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AJAINDER SHERGILL
Title or Position: OWNER
Credential: DO
Phone: 360-334-1882