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General NPI Number Information
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NPI Number | 1477085363
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLEAR INDUSTRIES
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 112 OZONE DR
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City | HAMMOND
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State | LA
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Zip | 70403-6018
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Country | US
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Telephone | 985-351-9614
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Fax | 985-542-4318
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Provider Business Mailing Address
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Address Line | 112 OZONE DR
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City | HAMMOND
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State | LA
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Zip | 70403-6018
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Country | US
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Telephone | 985-351-9614
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Fax | 985-542-4318
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Authorized Official
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Title or Position | CEO/CLINICIAL DIRECTOR
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Name | MRS. CRYSTAL S HOOPER
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Credential | LPC
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Telephone | 985-351-9614
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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 | 5976
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License Number State | LA
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