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General NPI Number Information
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NPI Number | 1104667369
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Entity Type | Organization
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Legal Business Name | CLEAR MIND THERAPY SOLUTIONS LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 2418 SUNLIGHT CT
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City | HENRYVILLE
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State | PA
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Zip | 18332-7910
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Country | US
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Telephone | 347-849-5385
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Fax |
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Provider Business Mailing Address
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Address Line | 1849 SOUTH RD STE 1004
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City | WAPPINGERS FALLS
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State | NY
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Zip | 12590-1360
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TISHAUN COOK
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Credential | LMSW
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Telephone | 347-849-5385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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