Healthcare Provider Details

I. General information

NPI: 1417866401
Provider Name (Legal Business Name): CLEAR MINDS HEALTH GROUP OF ARIZONA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 FEMRITE DR # 205C
MONONA WI
53716-3787
US

IV. Provider business mailing address

1250 FEMRITE DR # 205C
MONONA WI
53716-3787
US

V. Phone/Fax

Practice location:
  • Phone: 608-444-7961
  • Fax:
Mailing address:
  • Phone: 608-444-7961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TERRA KANE
Title or Position: MANAGING MEMBER
Credential: RN,BSN
Phone: 608-444-7961