Healthcare Provider Details

I. General information

NPI: 1780064048
Provider Name (Legal Business Name): CRYSTAL ANNE HALL LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19324 DUBLIN AVE
SANDY OR
97055-8115
US

IV. Provider business mailing address

5441 S MACADAM AVE STE N
PORTLAND OR
97239-3822
US

V. Phone/Fax

Practice location:
  • Phone: 503-751-8550
  • Fax: 971-385-6201
Mailing address:
  • Phone: 503-888-3548
  • Fax: 971-385-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 60732513
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC6920
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: