Provider Demographics
NPI:1508738758
Name:CRYSTAL CLEAR COUNSELING AND CONSULTING
Entity type:Organization
Organization Name:CRYSTAL CLEAR COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERIVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:857-445-2034
Mailing Address - Street 1:300 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1310
Mailing Address - Country:US
Mailing Address - Phone:857-445-2034
Mailing Address - Fax:
Practice Address - Street 1:300 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1310
Practice Address - Country:US
Practice Address - Phone:857-445-2034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty