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General NPI Number Information
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NPI Number | 1386903458
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Entity Type | Organization
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Legal Business Name | CLEAR MIND INC
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 1940 54TH ST
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City | SAN DIEGO
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State | CA
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Zip | 92105-5406
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Country | US
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Telephone | 323-839-7818
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Fax | 323-566-6025
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Provider Business Mailing Address
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Address Line | P.O. BOX 15821
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City | LOS ANGELES
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State | CA
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Zip | 90015
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Country | US
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Telephone | 323-839-7818
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Fax | 323-566-6025
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KELVIN DELENO FELIX
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Credential |
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Telephone | 323-839-7818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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