Provider Demographics
NPI:1477085363
Name:CRYSTAL CLEAR INDUSTRIES
Entity Type:Organization
Organization Name:CRYSTAL CLEAR INDUSTRIES
Other - Org Name:CRYSTAL CLEAR COUNSELING AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CLINICIAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:985-351-9614
Mailing Address - Street 1:112 OZONE DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6018
Mailing Address - Country:US
Mailing Address - Phone:985-351-9614
Mailing Address - Fax:985-542-4318
Practice Address - Street 1:112 OZONE DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6018
Practice Address - Country:US
Practice Address - Phone:985-351-9614
Practice Address - Fax:985-542-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5976251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health