Clear Water Therapy

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

CLEAR WATER THERAPY

Practice address

1202 Homelife PLZ
Rolla, MO 65401-2512

Phone

(573) 308-1540

NPI assigned

Oct 7, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rebecca Sidwell, LPCNPI 1972082840

Title

Owner

Phone

(303) 704-1967

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebecca Sidwell

  • Professional Counselor
  • Rolla, MO
  • NPI 1972082840
  Medicare reassignment Care Compare group NPD Authorized official
• Lori D Woods

  • Mental Health Counselor
  • Rolla, MO
  • NPI 1417660440
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1144861576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 HILLVIEW DR",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 HOMELIFE PLZ",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012512",
            "telephone_number": "573-308-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR WATER THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-07",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "SIDWELL",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-704-1967",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Brett Benson Clayton, PA-C
• Kathi D. Clement, MD
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• Sellas Pecos Coble, D.O.
• Jacob Edward Coffey, D.M.D
• Jeffrey M Cohen, LPC

• Mental Health Counselor in Rolla, MO
• Providers in Rolla, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.