Healthcare Provider Details

I. General information

NPI: 1033928023
Provider Name (Legal Business Name): KRYSTLE CLEAR COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S BROADWAY # 7
PITMAN NJ
08071-2235
US

IV. Provider business mailing address

140 S BROADWAY # 7
PITMAN NJ
08071-2235
US

V. Phone/Fax

Practice location:
  • Phone: 844-365-7676
  • Fax:
Mailing address:
  • Phone: 844-365-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRYSTLE LIND
Title or Position: OWNER/PROVIDER
Credential:
Phone: 856-426-6263