| Clear Water Therapy | |
|
1202 Homelife Plz Rolla MO 65401-2512 | |
| (573) 308-1540 | |
| Not Available |
| Full Name | Clear Water Therapy |
|---|---|
| Speciality | Counselor |
| Location | 1202 Homelife Plz, Rolla, Missouri |
| Authorized Official Name and Position | Rebecca Sidwell (OWNER) |
| Authorized Official Contact | 3037041967 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clear Water Therapy 1310 Hillview Dr Rolla MO 65401-2549 | Clear Water Therapy 1202 Homelife Plz Rolla MO 65401-2512 Ph: (573) 308-1540 |
| NPI Number | 1144861576 |
|---|---|
| Provider Enumeration Date | 10/07/2019 |
| Last Update Date | 11/18/2024 |
| Certification Date | 11/18/2024 |
| Medicare PECOS PAC ID | 9638682909 |
|---|---|
| Medicare Enrollment ID | O20250630003401 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144861576 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Primary |
| Provider Name | Rebecca Sidwell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972082840 PECOS PAC ID: 1456864727 Enrollment ID: I20250716002790 |
| Provider Name | Lori D Woods |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417660440 PECOS PAC ID: 4587164868 Enrollment ID: I20250821002561 |
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