=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114407657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARITY COACHING AND COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2018
-----------------------------------------------------
Last Update Date | 12/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1328 COUNTY RD 501
-----------------------------------------------------
City | BAYFIELD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81122-8112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-903-3354
-----------------------------------------------------
Fax | 970-442-4511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3696 COUNTY ROAD 502
-----------------------------------------------------
City | BAYFIELD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81122-9016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-903-3354
-----------------------------------------------------
Fax | 970-884-5004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ THERAPIST
-----------------------------------------------------
Name | JESSACA ANN CASSADY
-----------------------------------------------------
Credential | LCSW, LAC
-----------------------------------------------------
Telephone | 970-903-3354
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------