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General NPI Number Information
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NPI Number | 1790017721
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Entity Type | Organization
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Legal Business Name | CLEAR HORIZONS, LLC
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Dates
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Enumeration Date | 02/01/2010
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 1352 PHALEN BLVD
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City | SAINT PAUL
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State | MN
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Zip | 55106-2145
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Country | US
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Telephone | 651-324-0536
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Fax |
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Provider Business Mailing Address
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Address Line | 1352 PHALEN BLVD
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City | SAINT PAUL
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State | MN
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Zip | 55106-2145
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Country | US
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Telephone | 651-324-0536
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KRISHONE AKI HUGHES-POLK
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Credential | CPRP, LPCC
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Telephone | 651-324-0536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 174706
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 00024
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License Number State | MN
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