MEDICARE: CRYSTAL CLEAR COUNSELING & COACHING

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1659218907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL CLEAR COUNSELING & COACHING

Provider Business Mailing Address
First Line	:	6008 E CALEY AVE
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4257
Country	:	US
Telephone Number	:	303-587-0747
Fax Number	:

Provider Business Practice Location Address
First Line	:	6008 E CALEY AVE
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4257
Country	:	US
Telephone Number	:	303-587-0747
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	KELLY R TYRER
Credential	:	LPC, LAC
Telephone Number	:	303-587-0747

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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