Provider Demographics
NPI:1790493310
Name:CRYSTAL CLEAR CHILDREN AND YOUTH SERVICES
Entity Type:Organization
Organization Name:CRYSTAL CLEAR CHILDREN AND YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:P
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:254-638-8680
Mailing Address - Street 1:4304A E CENTRAL TEXAS EXPY STE A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-7308
Mailing Address - Country:US
Mailing Address - Phone:254-638-8680
Mailing Address - Fax:708-310-6057
Practice Address - Street 1:4304A E CENTRAL TEXAS EXPY STE A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-7308
Practice Address - Country:US
Practice Address - Phone:254-638-8680
Practice Address - Fax:708-310-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty