Individual provider Active NPI

Crystal Stachera, LMFT

  • Counselor
  • Beaverton, OR
National Provider Identifier
1053558239
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
T0898 Issued in OR
Practice address
6800 SW 105TH Ave Ste 101
Beaverton, OR 97008-5488
Phone
(971) 200-1966
Fax
(971) 754-4141
NPI assigned
Jan 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X T0898 OR
Counselor 101Y00000X T0898 OR Primary

Addresses

Primary practice location

6800 SW 105TH Ave Ste 101
Beaverton, OR 97008-5488

Mailing address

6800 SW 105TH Ave Ste 101
Beaverton, OR 97008-5488
Phone (971) 200-1966

Other practice location 1

113 E Hancock St
Newberg, OR 97132-2821
Phone (971) 200-1966

Other identifiers 1

IdentifierTypeStateIssuer
500740069MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
T0898ORMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Higher Ground Counseling Inc Counselor CurrentSince Oct 31, 2021 Accepting new patients

Locations

6800 SW 105th Ave
Ste 101
Beaverton, OR 97008
Phone (971) 200-1966

113 E Hancock St
Newberg, OR 97132
Phone (971) 200-1966

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1053558239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 SW 105TH AVE STE 101",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970085488",
            "telephone_number": "971-200-1966",
            "fax_number": "971-754-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 SW 105TH AVE STE 101",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970085488",
            "telephone_number": "971-200-1966",
            "fax_number": "971-754-4141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "113 E Hancock St",
            "address_purpose": "LOCATION",
            "city": "Newberg",
            "state": "OR",
            "postal_code": "971322821",
            "country_code": "US",
            "telephone_number": "971-200-1966",
            "fax_number": "971-754-4141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACHERA",
        "first_name": "CRYSTAL",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-09",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T0898",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": "T0898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500740069",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.