| Clear Path Counseling Of Tn, Llc | |
|
2306 Knob Creek Rd Ste 100 Johnson City TN 37604-2366 | |
| (423) 794-7596 | |
| (423) 610-1179 |
| Full Name | Clear Path Counseling Of Tn, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2306 Knob Creek Rd Ste 100, Johnson City, Tennessee |
| Authorized Official Name and Position | Ginger Yvonne Maddux (OWNER/COUNSELOR) |
| Authorized Official Contact | 4237947596 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clear Path Counseling Of Tn, Llc 1131 Antioch Rd Johnson City TN 37604-6379 Ph: (423) 794-7596 | Clear Path Counseling Of Tn, Llc 2306 Knob Creek Rd Ste 100 Johnson City TN 37604-2366 Ph: (423) 794-7596 |
| NPI Number | 1821868464 |
|---|---|
| Provider Enumeration Date | 01/04/2024 |
| Last Update Date | 01/04/2024 |
| Certification Date | 01/04/2024 |
| Medicare PECOS PAC ID | 0840634556 |
|---|---|
| Medicare Enrollment ID | O20240221003382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821868464 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ginger Y Ketron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295260537 PECOS PAC ID: 0648681569 Enrollment ID: I20201125002554 |
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