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General NPI Number Information
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NPI Number | 1700445350
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Entity Type | Organization
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Legal Business Name | CLEETHERAPY
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 395 PALM COAST PKWY SW UNIT 4
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City | PALM COAST
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State | FL
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Zip | 32137-4768
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Country | US
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Telephone | 904-512-0018
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Fax | 904-990-1680
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Provider Business Mailing Address
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Address Line | 395 PALM COAST PKWY SW UNIT 4
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City | PALM COAST
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State | FL
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Zip | 32137-4768
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Country | US
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Telephone | 904-512-0018
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Fax | 904-990-1680
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Authorized Official
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Title or Position | MANAGER
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Name | CHRISTINA LEE
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Credential | LCSW
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Telephone | 706-587-0934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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