Provider Demographics
NPI:1952719825
Name:CRYSTAL GARRISON NP, LLC
Entity Type:Organization
Organization Name:CRYSTAL GARRISON NP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, FAMILIY PMHNP
Authorized Official - Phone:360-907-1042
Mailing Address - Street 1:304 SE HEARTHWOOD BLVD # 871927
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-7551
Mailing Address - Country:US
Mailing Address - Phone:360-907-1042
Mailing Address - Fax:
Practice Address - Street 1:304 SE HEARTHWOOD BLVD # 871927
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-7551
Practice Address - Country:US
Practice Address - Phone:360-907-1042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60355508261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health