=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366888315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEAR CREEK COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2013
-----------------------------------------------------
Last Update Date | 05/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 HARRISON AVE STE 1
-----------------------------------------------------
City | ELKINS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26241-3492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-637-2660
-----------------------------------------------------
Fax | 304-637-2280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 97
-----------------------------------------------------
City | VALLEY HEAD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26294-0097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-637-2660
-----------------------------------------------------
Fax | 304-637-2680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ALEISHA GAIL ARBOGAST
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 304-637-2660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1008
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------