Healthcare Provider Details

I. General information

NPI: 1871302430
Provider Name (Legal Business Name): CRYSTAL LARIMORE CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1538
NEWPORT OR
97365-0115
US

IV. Provider business mailing address

PO BOX 1538
NEWPORT OR
97365-0115
US

V. Phone/Fax

Practice location:
  • Phone: 541-574-9570
  • Fax: 541-574-8857
Mailing address:
  • Phone: 541-574-9570
  • Fax: 541-574-8857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24-CRM-3873
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: