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General NPI Number Information
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NPI Number | 1952719825
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Entity Type | Organization
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Legal Business Name | CRYSTAL GARRISON NP, LLC
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 304 SE HEARTHWOOD BLVD # 871927
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City | VANCOUVER
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State | WA
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Zip | 98684-7551
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Country | US
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Telephone | 360-907-1042
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Fax |
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Provider Business Mailing Address
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Address Line | 304 SE HEARTHWOOD BLVD # 871927
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City | VANCOUVER
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State | WA
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Zip | 98684-7551
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Country | US
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Telephone | 360-907-1042
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Fax |
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Authorized Official
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Title or Position | FAMILY PSYCHIATRIC MENTAL HEALTH NP
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Name | CRYSTAL GARRISON
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Credential | ARNP, FAMILIY PMHNP
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Telephone | 360-907-1042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | AP60355508
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | AP60355508
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License Number State | WA
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