Active NPI
Crystal Rose Wiss
- Professional Counselor
- Lebanon, OR
National Provider Identifier
1265262612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C8013
- Practice address
- 1600 S Main St
Lebanon, OR 97355-3109 - Phone
- (541) 451-5932
- Fax
- (541) 812-8807
- NPI assigned
- Aug 1, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C8013 | OR | Primary |
Addresses
Primary practice location
1600 S Main St
Lebanon, OR 97355-3109
Mailing address
PO Box 100
Albany, OR 97321-0031
Phone (541) 967-3866
Other names 1
- Crystal Rose Haskins
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
139 SW 3Rd St
Corvallis, OR 97333-4713
Phone (541) 908-1095
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conifer Wellness, Inc. | Current | Accepting new patients |
Locations
139 SW 3rd St
Corvallis, OR 97333
Phone (248) 303-3751
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Corvallis, OR
- NPI 1912551771
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722470400000",
"number": "1265262612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 100",
"city": "ALBANY",
"state": "OR",
"postal_code": "973210031",
"telephone_number": "541-967-3866",
"fax_number": "541-812-8807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 S MAIN ST",
"city": "LEBANON",
"state": "OR",
"postal_code": "973553109",
"telephone_number": "541-451-5932",
"fax_number": "541-812-8807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISS",
"first_name": "CRYSTAL",
"middle_name": "ROSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-01",
"last_updated": "2024-08-01",
"certification_date": "2024-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C8013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CRYSTAL",
"last_name": "HASKINS",
"middle_name": "ROSE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lebanon, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.