=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992680219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEAR MIND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2025
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 WEST ST UNIT 14
-----------------------------------------------------
City | PLANTSVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06479-1171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-208-4995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 WEST ST UNIT 14
-----------------------------------------------------
City | PLANTSVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06479-1171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-208-4995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MELISSA OBER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 860-208-4995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------