MEDICARE: CRYSTAL CLEAR MENTAL HEALTH LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1053279224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL CLEAR MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	6858 JACK HORNER LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3618
Country	:	US
Telephone Number	:	315-816-2541
Fax Number	:

Provider Business Practice Location Address
First Line	:	6858 JACK HORNER LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3618
Country	:	US
Telephone Number	:	315-816-2541
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARTHA E LINAN
Credential	:	PMHNP
Telephone Number	:	315-816-2541

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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