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General NPI Number Information
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NPI Number | 1669860672
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Entity Type | Organization
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Legal Business Name | CLEARWATER COUNSELING
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 4717 GUNBARREL PL
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City | GRAND ISLAND
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State | NE
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Zip | 68801-8504
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Country | US
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Telephone | 308-850-7190
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Fax |
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Provider Business Mailing Address
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Address Line | 4717 GUNBARREL PL
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City | GRAND ISLAND
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State | NE
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Zip | 68801-8504
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Country | US
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Telephone | 308-850-7190
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. CYNTHIA L. MCDOWELL
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Credential | LIMHP
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Telephone | 308-850-7190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1178
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License Number State | NE
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