Provider Demographics
NPI:1003983479
Name:CRIMP, ERICA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:CRIMP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:38934 MARYS RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BLODGETT
Mailing Address - State:OR
Mailing Address - Zip Code:97326-9422
Mailing Address - Country:US
Mailing Address - Phone:541-456-2201
Mailing Address - Fax:
Practice Address - Street 1:833 NW BUCHANAN AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6217
Practice Address - Country:US
Practice Address - Phone:541-602-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR128715Medicaid