Provider Demographics
NPI:1386903458
Name:CLEAR MIND INC
Entity type:Organization
Organization Name:CLEAR MIND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:DELENO
Authorized Official - Last Name:FELIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-839-7818
Mailing Address - Street 1:P.O. BOX 15821
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015
Mailing Address - Country:US
Mailing Address - Phone:323-839-7818
Mailing Address - Fax:323-566-6025
Practice Address - Street 1:1940 54TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5406
Practice Address - Country:US
Practice Address - Phone:323-839-7818
Practice Address - Fax:323-566-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty