Provider Demographics
NPI:1265893267
Name:CRISP, PATRICE (CADC II, QMHA II)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:CRISP
Suffix:
Gender:F
Credentials:CADC II, QMHA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 PRICE RD SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-7314
Mailing Address - Country:US
Mailing Address - Phone:541-928-9681
Mailing Address - Fax:541-928-5990
Practice Address - Street 1:1050 PRICE RD SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-7314
Practice Address - Country:US
Practice Address - Phone:541-928-9681
Practice Address - Fax:541-928-5990
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health