Active NPI
Crystal Louise Green
- Mental Health Counselor
- Shelton, WA
National Provider Identifier
1114535150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 307 W Cota St
Shelton, WA 98584-2265 - Phone
- (360) 839-2822
- Fax
- (360) 839-2822
- NPI assigned
- Jul 15, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
307 W Cota St
Shelton, WA 98584-2265
Mailing address
19206 21St St SW
Lakebay, WA 98349-9280
Phone (125) 329-2888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100000034753 | Medicaid | WA |
Other names 1
- Ms. Crystal Louise Burns
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | vdechon@telecarecorp.com | Direct |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594771200000",
"number": "1114535150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19206 21ST ST SW",
"city": "LAKEBAY",
"state": "WA",
"postal_code": "983499280",
"telephone_number": "125-329-2888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 W COTA ST",
"city": "SHELTON",
"state": "WA",
"postal_code": "985842265",
"telephone_number": "360-839-2822",
"fax_number": "360-839-2822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "CRYSTAL",
"middle_name": "LOUISE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-15",
"last_updated": "2020-07-15",
"certification_date": "2020-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100000034753",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "vdechon@telecarecorp.com",
"affiliation": "N",
"endpointDescription": "email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "307 W Cota St",
"city": "Shelton",
"state": "WA",
"country_code": "US",
"postal_code": "985842265",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "CRYSTAL",
"last_name": "BURNS",
"middle_name": "LOUISE",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Shelton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.