MEDICARE: CLEAR INNERVISION COUNSELING SERVICE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801070834	MI

General Provider Information

NPI Number	:	1073025854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR INNERVISION COUNSELING SERVICE, LLC

Provider Business Mailing Address
First Line	:	16249 EASTWIND ST
Second Line	:
City	:	ROMULUS
State	:	MI
Zip	:	48174-3180
Country	:	US
Telephone Number	:	313-467-3918
Fax Number	:

Provider Business Practice Location Address
First Line	:	19304 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1202
Country	:	US
Telephone Number	:	313-467-3918
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RHONDA JOVETTE MILLER
Credential	:	LMSW
Telephone Number	:	313-467-7215

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	01/22/2018

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