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General NPI Number Information
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NPI Number | 1407208390
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Entity Type | Organization
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Legal Business Name | CLEAR MIND THERAPY LLC
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 300 W BROADWAY STE 706
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4489
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Country | US
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Telephone | 712-256-9902
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Fax | 712-256-9903
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Provider Business Mailing Address
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Address Line | 300 W BROADWAY STE 706
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4489
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Country | US
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Telephone | 712-256-9902
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Fax | 712-256-9903
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Authorized Official
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Title or Position | CO OWNER
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Name | CIARA WARDEN
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Credential | LISW
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Telephone | 712-256-9902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007763
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001147
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License Number State | IA
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