Healthcare Provider Details

I. General information

NPI: 1861301624
Provider Name (Legal Business Name): RIVERSIDE CLINICAL COUNSELING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W A ST UNIT 1671
RAINIER OR
97048-0860
US

IV. Provider business mailing address

207 W A ST UNIT 1671
RAINIER OR
97048-0860
US

V. Phone/Fax

Practice location:
  • Phone: 503-935-7770
  • Fax: 503-597-8968
Mailing address:
  • Phone: 503-935-7770
  • Fax: 503-597-8968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL HARREL
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 503-935-7770