=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013887512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEARMIND MENTAL HEALTH THERAPY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2025
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 E CECIL AVE STE B
-----------------------------------------------------
City | NORTH EAST
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21901-4057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-350-5447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 163 RIVERSIDE DR
-----------------------------------------------------
City | ELKTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21921-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA BURANEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-350-5447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------