MEDICARE: CLEAR VISION PSYCHIATRIC CONSULTANTS PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1225987985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR VISION PSYCHIATRIC CONSULTANTS PLLC

Provider Business Mailing Address
First Line	:	9832 LOGANS RIDGE DR
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2765
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9832 LOGANS RIDGE
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109
Country	:	US
Telephone Number	:	210-675-0066
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROCHELLE STATEN
Credential	:
Telephone Number	:	210-952-7316

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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