Tabula Rasa Wellness LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

TABULA RASA WELLNESS LLC

Practice address

2105 Liberty St NE
Salem, OR 97301-8353

Phone

(503) 967-3428

Fax

(503) 967-3683

NPI assigned

Jan 16, 2019

Last updated

Jan 31, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lindsay Crowner, LCSWNPI 1295181246

Title

Owner/Clinical Social Worker

Phone

(509) 430-7578

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lindsay Nichole Crowner

  • Counselor
  • Salem, OR
  • NPI 1295181246
  Medicare reassignment Care Compare group NPD Authorized official
• Lori G Kloss

  • Professional Counselor
  • Albany, OR
  • NPI 1871146316
  Medicare reassignment Care Compare group NPD
• Niki L. Young

  • Clinical Social Worker
  • Vancouver, WA
  • NPI 1164931614

  OR

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612051200000",
    "number": "1205300837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 LIBERTY RD S APT 65",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973026628",
            "telephone_number": "509-430-7578",
            "fax_number": "503-967-3683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 LIBERTY ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973018353",
            "telephone_number": "503-967-3428",
            "fax_number": "503-967-3683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABULA RASA WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-16",
        "last_updated": "2021-01-31",
        "certification_date": "2021-01-31",
        "status": "A",
        "authorized_official_last_name": "CROWNER",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "OWNER/CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "509-430-7578",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carissa Synder
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• T2 Imaging, Inc.
• Elizabeth Maree Tabor, PHARMD
• Misty C. Tacker, BSN RN
• Regina Gaye Tackett-Nelson
• Steven Charles Tackett-Nelson, M.D.
• Vanessa Maria Tadeo
• Guinevere Noelle Tadina, RDH

• Clinical Social Worker in Salem, OR
• Providers in Salem, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.