Provider Demographics
NPI:1427627892
Name:CLEAR CONNECTIONS COUNSELING LLC
Entity type:Organization
Organization Name:CLEAR CONNECTIONS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JOHNSON-GIBEAUT
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC, CTT
Authorized Official - Phone:304-610-2477
Mailing Address - Street 1:714 VENTURE DR # 122
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-7306
Mailing Address - Country:US
Mailing Address - Phone:304-504-4030
Mailing Address - Fax:
Practice Address - Street 1:714 VENTURE DR # 122
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-7306
Practice Address - Country:US
Practice Address - Phone:304-504-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty