| Crystal Clear Behavioral Health Services Inc | |
|
4304a E Central Texas Expy Ste A Killeen TX 76543-7308 | |
| (708) 275-0937 | |
| (708) 310-6057 |
| Full Name | Crystal Clear Behavioral Health Services Inc |
|---|---|
| Speciality | Social Worker |
| Location | 4304a E Central Texas Expy Ste A, Killeen, Texas |
| Authorized Official Name and Position | Tamara Patrice Fields (PRESIDENT) |
| Authorized Official Contact | 7082750937 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Clear Behavioral Health Services Inc 4304a E Central Texas Expy Ste A Killeen TX 76543-7308 Ph: (708) 275-0937 | Crystal Clear Behavioral Health Services Inc 4304a E Central Texas Expy Ste A Killeen TX 76543-7308 Ph: (708) 275-0937 |
| NPI Number | 1356884001 |
|---|---|
| Provider Enumeration Date | 11/29/2016 |
| Last Update Date | 09/17/2020 |
| Certification Date | 09/17/2020 |
| Medicare PECOS PAC ID | 4789942871 |
|---|---|
| Medicare Enrollment ID | O20171219001218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356884001 | NPI | - | NPPES |
| 342420202 | Medicaid | TX | |
| 342420203 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 58569 (Texas) | Primary |
| Provider Name | Tamara Fields |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962743328 PECOS PAC ID: 4880815448 Enrollment ID: I20141023000988 |
| Provider Name | Wilzata Ann Buie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508291501 PECOS PAC ID: 8325383482 Enrollment ID: I20181218000462 |
| Provider Name | Kelly Sue Contreras |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801560339 PECOS PAC ID: 1254739493 Enrollment ID: I20211001002220 |
| Provider Name | Aaron W Moon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265138564 PECOS PAC ID: 8729453170 Enrollment ID: I20230417001963 |
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