Provider Demographics
NPI:1053620922
Name:CLEARY, BOBBI MOORE (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:BOBBI
Middle Name:MOORE
Last Name:CLEARY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:MOORE
Other - Last Name:O'KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:1585 MISSION ROAD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603
Mailing Address - Country:US
Mailing Address - Phone:907-440-6405
Mailing Address - Fax:888-719-1194
Practice Address - Street 1:1585 MISSION ROAD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603
Practice Address - Country:US
Practice Address - Phone:907-440-6405
Practice Address - Fax:888-719-1194
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional