Crystal Marie Harris, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

101995 Issued in CA

Practice address

30750 Simpson LN
Fort Bragg, CA 95437-7761

Phone

(970) 903-1761

NPI assigned

Jul 18, 2019

Last updated

May 31, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mendocino Coast Clinics, IncGroup PAC ID 5991619157, 19 clinicians

Sud Specialty Group - CaGroup PAC ID 9537534177, 519 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: crystallcsw.harris.p1@direct.mccinc.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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

• Mendocino Coast Clinics Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Bragg, CA
  • NPI 1609595404
  Medicare reassignment Care Compare group NPD
• Sud Specialty Group - Ca

  dba Rula Health

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Clinical

  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Clinical

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, CO

  Medicare reassignment NPD
• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442
  Medicare reassignment NPD
• Sondermind PC

  • Clinical Social Worker
  • San Jose, CA
  • NPI 1003646977
  Medicare reassignment
• Mendocino Coast Clinics Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Bragg, CA
  • NPI 1083783757
  NPD
• Mendocino Coast Clinics, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fort Bragg, CA
  • NPI 1285128595
  NPD

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1083267165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30750 SIMPSON LN",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954377761",
            "telephone_number": "970-903-1761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30750 SIMPSON LN",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954377761",
            "telephone_number": "970-903-1761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "CRYSTAL",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-18",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": ".09924293",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "101995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Rueze Hackley, P.T.
• Gretchen Hahn, LMFT
• Amelia Hanney, DDS
• Happy Rides Inc.
• Happy Rides LLC
• Diane I. Harris, MD
• Elizabeth Hayes Harvey
• Emily Jasmine Head, LAC, MAOM
• Arwen Hebden
• Elaine Heine

• Clinical Social Worker in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.