| Organization Name: | CRYSTAL CLEAR BEHAVIORAL HEALTH SERVICES |
| NPI Number: | 1114366531 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAMARA FIELDS (OWNER) |
| Mailing Address: | 1818 Ridge Road Unit 104 Homewood |
| State: | IL US |
| Postal Code: | 604301763 |
| Phone Number: | 7082750937 |
| Fax Number: | 8155211889 |
| NPI Enumeration Date: | 06/19/2013 |
| NPI Last Update Date: | 06/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149.014385 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |