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General NPI Number Information
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NPI Number | 1386970267
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Entity Type | Organization
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Legal Business Name | CRYSTAL F. CLAIR, INC
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 3118 N SHEFFIELD AVE STE 1S
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City | CHICAGO
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State | IL
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Zip | 60657-9139
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Country | US
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Telephone | 312-618-4867
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 N SHEFFIELD AVE STE 1S
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City | CHICAGO
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State | IL
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Zip | 60657-9139
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Country | US
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Telephone | 312-618-4867
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Fax |
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Authorized Official
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Title or Position | CLINICAL COUNSELOR
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Name | CRYSTAL FAITH CLAIR
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Credential | M.A., LCPC
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Telephone | 312-618-4867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180.007066
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License Number State | IL
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