MEDICARE: CLEAR COAST VENTURES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	106H00000X	Marriage & Family Therapist
4	221700000X	Art Therapist
5	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1003787177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR COAST VENTURES LLC

Provider Business Mailing Address
First Line	:	1234 MYRTLE ST
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-5931
Country	:	US
Telephone Number	:	310-623-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 MYRTLE ST
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-5931
Country	:	US
Telephone Number	:	310-623-2244
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEPHANIE ROBINSON
Credential	:
Telephone Number	:	310-623-2244

Provider Enumeration Date	:	09/13/2025
Last Update Date	:	09/13/2025

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