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General NPI Number Information
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NPI Number | 1235066945
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Entity Type | Organization
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Legal Business Name | CLEARLANE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 2780 E FOWLER AVE # 601
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City | TAMPA
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State | FL
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Zip | 33612-6297
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Country | US
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Telephone | 813-444-2276
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Fax | 614-412-2522
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Provider Business Mailing Address
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Address Line | 2780 E FOWLER AVE # 601
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City | TAMPA
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State | FL
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Zip | 33612-6297
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Country | US
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Telephone | 813-444-2276
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Fax | 614-412-2522
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | COURTNEY WILDER-WHITING
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Credential | APRN, FNP-C, PMHNP-C
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Telephone | 813-444-2276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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