1003983479 NPI number — MRS. ERICA CRIMP LPC

Table of content: MRS. ERICA CRIMP LPC (NPI 1003983479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003983479 NPI number — MRS. ERICA CRIMP LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRIMP
Provider First Name:
ERICA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANDERS
Provider Other First Name:
ERICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003983479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38934 MARYS RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLODGETT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97326-9422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-456-2201
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 NW BUCHANAN AVE
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97330-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-602-6760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 128715 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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