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NPI Code Detail

MEDICARE: MRS. CRYSTAL AMBER HARRIS LICSW

MEDICARE: MRS. CRYSTAL AMBER HARRIS LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLW61629844WA

General Provider Information

NPI Number : 1548995764
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CRYSTAL AMBER HARRIS LICSW
Provider Business Mailing Address
First Line : 5008 W HOFFMAN PL
Second Line :
City : SPOKANE
State : WA
Zip : 99205-1922
Country : US
Telephone Number : 509-723-8733
Fax Number :
Provider Business Practice Location Address
First Line : 4815 N ASSEMBLY ST
Second Line :
City : SPOKANE
State : WA
Zip : 99205-6185
Country : US
Telephone Number : 509-434-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2022
Last Update Date : 12/31/2025

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