=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326696188
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HENRY SYDNEY CRAPSER SR. CRM CADC-R
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2019
-----------------------------------------------------
Last Update Date | 08/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2045 SILVERTON RD NE STE A
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97301-0100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-588-5358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2045 SILVERTON RD NE STE A
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97301-0100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-576-4660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------