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General NPI Number Information
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NPI Number | 1326589375
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Entity Type | Organization
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Legal Business Name | CLEAR WATER THERAPY, LLC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 732 CHAUNCEY ST
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4207
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Country | US
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Telephone | 715-835-4911
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 504
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City | EAU CLAIRE
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State | WI
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Zip | 54702-0504
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Country | US
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Telephone | 715-835-4911
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CAREY R HOEFT
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Credential | MS MFT
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Telephone | 715-835-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | WI
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