Provider Demographics
NPI:1346565801
Name:NEBEKER, CRYSTAL ANN (CDP, CADC I, BS)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:ANN
Last Name:NEBEKER
Suffix:
Gender:F
Credentials:CDP, CADC I, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 NE SUNDERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-1708
Mailing Address - Country:US
Mailing Address - Phone:503-280-6646
Mailing Address - Fax:503-280-6081
Practice Address - Street 1:9111 NE SUNDERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-1708
Practice Address - Country:US
Practice Address - Phone:503-280-6646
Practice Address - Fax:360-280-6081
Is Sole Proprietor?:No
Enumeration Date:2010-03-28
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60130440101YA0400X
OR09-09-37171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)