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General NPI Number Information
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NPI Number | 1821888264
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Entity Type | Organization
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Legal Business Name | CLEAR PATH PSYCHIATRY PLLC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 100 S 2ND ST STE B
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City | EAGLE LAKE
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State | MN
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Zip | 56024-7714
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Country | US
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Telephone | 507-978-4543
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Fax |
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Provider Business Mailing Address
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Address Line | 100 S 2ND ST STE B
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City | EAGLE LAKE
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State | MN
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Zip | 56024-7714
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Country | US
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Telephone | 507-654-0020
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER - OWNER
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Name | ALEXANDRO VASQUEZ
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Credential | NURSE PRACTITIONER
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Telephone | 507-654-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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