Healthcare Provider Details

I. General information

NPI: 1780017525
Provider Name (Legal Business Name): CRYSTAL LOUISE GARRISON ARNP/FAMILY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL LOUISE THOMPSON WA RN & OREGON RN

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

2103 NE 129TH ST STE 101
VANCOUVER WA
98686-3270
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-2000
  • Fax: 360-514-1846
Mailing address:
  • Phone: 360-574-9303
  • Fax: 360-574-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60355508
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: