1649861444 NPI number — CLEAR CONSULTING GROUP

Table of content: (NPI 1649861444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649861444 NPI number — CLEAR CONSULTING GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEAR CONSULTING GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLEAR COUNSELING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649861444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6222 RAYTOWN TRFY STE 178
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYTOWN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64133-3847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-674-2657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10109 E 63RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYTOWN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64133-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-533-6308
Provider Business Practice Location Address Fax Number:
816-662-7632
Provider Enumeration Date:
02/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HICKS
Authorized Official First Name:
KENYA
Authorized Official Middle Name:
Authorized Official Title or Position:
TRAUMA CLINICIAN
Authorized Official Telephone Number:
816-674-2657

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1356964738 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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