Provider Demographics
NPI:1508242736
Name:CHRYSTAL, JONATHAN (QMHP)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:CHRYSTAL
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 NE 24TH AVE
Mailing Address - Street 2:#106
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1669
Mailing Address - Country:US
Mailing Address - Phone:312-805-6179
Mailing Address - Fax:
Practice Address - Street 1:3878 BEVERLY AVE NE
Practice Address - Street 2:H SUITE 11
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1394
Practice Address - Country:US
Practice Address - Phone:503-576-4600
Practice Address - Fax:503-584-4837
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health