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General NPI Number Information
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NPI Number | 1205979168
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Entity Type | Organization
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Legal Business Name | CLEARWATER COUNSELING AND PERSONAL GROWTH CENTER, INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4330 GOLF TER SUITE 213M
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4683
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Country | US
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Telephone | 715-832-4060
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Fax | 715-832-5914
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Provider Business Mailing Address
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Address Line | 4330 GOLF TER SUITE 213M
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4683
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Country | US
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Telephone | 715-832-4060
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Fax | 715-832-5914
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Authorized Official
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Title or Position | DIRECTOR
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Name | JANICE SUSAN O'CONNOR
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Credential | M.S.W., L.C.S.W.
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Telephone | 715-832-4060
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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
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License Number | 1203
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License Number State | WI
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