Provider Demographics
NPI:1194561522
Name:CLEAR DIRECTION PSYCHOLOGICAL SERVICES, INC
Entity type:Organization
Organization Name:CLEAR DIRECTION PSYCHOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VANPORTFLIET
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-874-8624
Mailing Address - Street 1:2127 OLYMPIC PKWY
Mailing Address - Street 2:STE 1006-363
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2127 OLYMPIC PKWY
Practice Address - Street 2:STE 1006-363
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915
Practice Address - Country:US
Practice Address - Phone:619-874-8624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health