Provider Demographics
NPI:1144707175
Name:CLEAR & CREATIVE COUNSELING LLC
Entity type:Organization
Organization Name:CLEAR & CREATIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANDEMER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-787-5558
Mailing Address - Street 1:2323 CLEAR LAKE CITY BLVD STE 180-308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-8120
Mailing Address - Country:US
Mailing Address - Phone:281-787-5558
Mailing Address - Fax:
Practice Address - Street 1:17300 EL CAMINO REAL STE 107D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2715
Practice Address - Country:US
Practice Address - Phone:281-787-5558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3650327-01Medicaid