MEDICARE: CLEAR MIND COUNSELING 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1275179343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR MIND COUNSELING PLLC

Provider Business Mailing Address
First Line	:	12018 MILL BERGER
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-5606
Country	:	US
Telephone Number	:	210-504-6043
Fax Number	:

Provider Business Practice Location Address
First Line	:	12018 MILL BERGER
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-5606
Country	:	US
Telephone Number	:	210-504-6043
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ASHLEY P CUEVAS
Credential	:	PHD, LPC, NCC
Telephone Number	:	512-644-8563

Provider Enumeration Date	:	11/22/2019
Last Update Date	:	11/22/2019

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