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General NPI Number Information
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NPI Number | 1871334516
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Entity Type | Organization
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Legal Business Name | CLEAR RIVER COUNSELING AND WELLNESS, PLLC
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 2803 CENTRAL ST. SUITE A
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City | MELISSA
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State | TX
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Zip | 75454
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Country | US
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Telephone | 972-265-9140
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 WHITETAIL LN
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City | MELISSA
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State | TX
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Zip | 75454-0610
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/CEO
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Name | ZACH SMALL
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Credential | MS
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Telephone | 972-265-9140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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