Healthcare Provider Details

I. General information

NPI: 1295846483
Provider Name (Legal Business Name): SHAWN R CRISWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 SALEM DALLAS HWY NW
SALEM OR
97304-3338
US

IV. Provider business mailing address

105 WOODSON ST UNIT 499
AMITY OR
97101-0809
US

V. Phone/Fax

Practice location:
  • Phone: 503-575-6289
  • Fax:
Mailing address:
  • Phone: 503-575-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1079
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005103
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: