NPIMap

Organization Active NPI

Clear Mind Therapy LLC

  • Mental Health Counselor
  • Council Bluffs, IA
National Provider Identifier
1407208390
Registry record updated Jul 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
001147 Issued in IA
Legal business name
CLEAR MIND THERAPY LLC
Practice address
300 W Broadway Ste 706
Council Bluffs, IA 51503-4489
Phone
(712) 256-9902
Fax
(712) 256-9903
NPI assigned
Jul 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2016

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

Authorized official

Name
Ciara Warden, LISWNPI 1316205743
Title
Co Owner
Phone
(712) 256-9902

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 001147 IA Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 007763 IA

Addresses

Primary practice location

300 W Broadway Ste 706
Council Bluffs, IA 51503-4489

Mailing address

300 W Broadway Ste 706
Council Bluffs, IA 51503-4489
Phone (712) 256-9902

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171026001747 IA Part B Supplier - Clinic/Group Practice 4486920089 Receives reassigned benefits from 6 practitioners
Practice locations: Council Bluffs, IA

National Provider Directory

National Provider Directory

Locations

300 W Broadway
Ste 706
Council Bluffs, IA 51503
Phone (712) 256-9902

35 Main Pl
Ste 100
Council Bluffs, IA 51503
Phone (712) 256-9902

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467676800000",
    "number": "1407208390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W BROADWAY STE 706",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034489",
            "telephone_number": "712-256-9902",
            "fax_number": "712-256-9903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W BROADWAY STE 706",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034489",
            "telephone_number": "712-256-9902",
            "fax_number": "712-256-9903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR MIND THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-05",
        "last_updated": "2016-07-05",
        "status": "A",
        "authorized_official_last_name": "WARDEN",
        "authorized_official_first_name": "CIARA",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "712-256-9902",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001147",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "007763",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; 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.