MEDICARE: KRYSTAL CLEAR COUNSELING PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6401011876	OTHER	MI	LICENSE NUMBER

General Provider Information

NPI Number	:	1932842291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRYSTAL CLEAR COUNSELING PLLC

Provider Business Mailing Address
First Line	:	13854 LAKESIDE CIR STE 225
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-1443
Country	:	US
Telephone Number	:	586-339-5744
Fax Number	:

Provider Business Practice Location Address
First Line	:	13854 LAKESIDE CIR STE 225
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-1443
Country	:	US
Telephone Number	:	586-339-5744
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRYSTAL ARMSTRONG
Credential	:	MA LPC CADC
Telephone Number	:	586-339-5744

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	04/15/2022

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