Provider Demographics
NPI:1568914927
Name:CLEAR CREEK COUNSELING
Entity type:Organization
Organization Name:CLEAR CREEK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOENEN
Authorized Official - Suffix:
Authorized Official - Credentials:PLPC
Authorized Official - Phone:573-619-8919
Mailing Address - Street 1:3646 NORTH FARM ROAD 89
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781
Mailing Address - Country:US
Mailing Address - Phone:417-850-4555
Mailing Address - Fax:
Practice Address - Street 1:3646 N FARM ROAD 89
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-8330
Practice Address - Country:US
Practice Address - Phone:573-619-8919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035718322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children