MEDICARE: CLARITY COUNSELING & WELLNESS, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1730715434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARITY COUNSELING & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	304 WILLIAMS ST STE N
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1648
Country	:	US
Telephone Number	:	419-921-8347
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 WILLIAMS ST STE N
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1648
Country	:	US
Telephone Number	:	419-921-8347
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	ASHLEY MODOLO
Credential	:	MS, LPCC-S
Telephone Number	:	419-921-8347

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	03/13/2020

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