Provider Demographics
NPI:1669818522
Name:HARREL, CRYSTAL NICHOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICHOLE
Last Name:HARREL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W A ST UNIT 1671
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-0860
Mailing Address - Country:US
Mailing Address - Phone:503-935-7770
Mailing Address - Fax:503-597-8968
Practice Address - Street 1:207 W A ST UNIT 1671
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-0860
Practice Address - Country:US
Practice Address - Phone:503-935-7770
Practice Address - Fax:503-597-8968
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1669818522101YM0800X
OR390200000X
ORL105111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR195164Medicaid