MEDICARE: CRYSTAL CLEAR COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1437007945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL CLEAR COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	7901 4TH ST N STE 300
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-4399
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 DATE DR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-3337
Country	:	US
Telephone Number	:	321-641-4810
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	ALEXANDRA RUETZ
Credential	:	LMHC
Telephone Number	:	321-641-4810

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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