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General NPI Number Information
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NPI Number | 1194653543
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Entity Type | Organization
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Legal Business Name | CLEAR MIND THERAPY LLC.
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Dates
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Enumeration Date | 05/13/2026
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Last Update Date | 05/13/2026
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Provider Practice Location Address
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Address Line | 1506 16TH ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-3344
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Country | US
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Telephone | 248-504-7094
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Fax | 248-504-7094
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Provider Business Mailing Address
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Address Line | 1506 16TH ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-3344
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Country | US
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Telephone | 248-504-7094
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Fax | 248-504-7094
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | KRISTEN NICOLLE EIBEN
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Credential | LMSW
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Telephone | 248-504-7094
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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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