MEDICARE: CRYSTAL CLEAR THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker
3	104100000X	Social Worker
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	101YP1600X	Pastoral Counselor
6	101YA0400X	Addiction (Substance Use Disorder) Counselor
7	101YM0800X	Mental Health Counselor
8	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669294666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL CLEAR THERAPY PLLC

Provider Business Mailing Address
First Line	:	4101 MCEWEN RD STE 346
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5276
Country	:	US
Telephone Number	:	214-336-4417
Fax Number	:	214-377-6247

Provider Business Practice Location Address
First Line	:	4101 MCEWEN RD STE 346
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5276
Country	:	US
Telephone Number	:	214-336-4417
Fax Number	:	214-377-6247

Authorized Official
Title or Position	:	OWNER
Name	:	DIAMOND S WALKER
Credential	:	M.A, LPC, C-DBT, CTP
Telephone Number	:	214-336-4417

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	03/16/2026

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Directions to “CRYSTAL CLEAR THERAPY PLLC ” Practice Location

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