Cleetherapy

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CLEETHERAPY

Practice address

395 Palm Coast Pkwy SW Unit 4
Palm Coast, FL 32137-4768

Phone

(904) 512-0018

Fax

(904) 990-1680

NPI assigned

Jun 7, 2019

Last updated

Jan 29, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christina Lee, LCSWNPI 1992298921

Title

Manager

Phone

(706) 587-0934

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christina R Lee, LCSW

  • Clinical Social Worker
  • Palm Coast, FL
  • NPI 1992298921
  Medicare reassignment NPD Authorized official
• Sara Fulkerson

  • Clinical Social Worker
  • Palm Coast, FL
  • NPI 1447840657
  NPD

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1700445350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 PALM COAST PKWY SW UNIT 4",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321374768",
            "telephone_number": "904-512-0018",
            "fax_number": "904-990-1680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 PALM COAST PKWY SW UNIT 4",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321374768",
            "telephone_number": "904-512-0018",
            "fax_number": "904-990-1680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEETHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-07",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "706-587-0934",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Maurene Clark, M.S CCC SLP
• Yolanda Clark, LPN
• Amanda Soto Clarke, RN
• Astrid Grace Clarke, MD
• Nayvette Claudio, RBT ASSISSTANT
• Ashley Lynn Clerkin
• Kimberly Clough, FNP-C
• Jenna Coakley, COTA/L
• Elise Coan
• Coastal Care Medical Transport

• Mental Health Clinic/Center (Including Community Mental Health Center) in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; 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.