MEDICARE: NICHOLAS MATHIAS THOMAS CRAPSER MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	60327803	WA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	15-R-27	OR
3	101YM0800X	Mental Health Counselor	60722084	WA
4	101YP2500X	Professional Counselor	C-4563	OR

General Provider Information

NPI Number	:	1235482266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MATHIAS THOMAS CRAPSER MA

Provider Business Mailing Address
First Line	:	10920 SW BARBUR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-8600
Country	:	US
Telephone Number	:	360-442-1451
Fax Number	:

Provider Business Practice Location Address
First Line	:	10920 SW BARBUR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-8600
Country	:	US
Telephone Number	:	360-442-1451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	12/08/2022

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