Chrystal Jean Ellis

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1011 Commercial St NE Ste 110
Salem, OR 97301-1036

Phone

(503) 983-9900

Fax

(503) 983-9899

NPI assigned

Nov 29, 2018

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• CRC Health Oregon, LLC

  • Methadone Clinic
  • Salem, OR
  • NPI 1427397074
  NPD (past)
• CRC Health Oregon, LLC

  • Methadone Clinic
  • Albany, OR
  • NPI 1811561731
  NPD (past)

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1427528751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 COMMERCIAL ST NE STE 110",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011036",
            "telephone_number": "503-983-9900",
            "fax_number": "503-983-9899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 COMMERCIAL ST NE STE 110",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011036",
            "telephone_number": "503-983-9900",
            "fax_number": "503-983-9899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1160 Liberty St SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973024143",
            "country_code": "US",
            "telephone_number": "503-391-9762",
            "fax_number": "503-315-2019",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "213 NE 10th St",
            "address_purpose": "LOCATION",
            "city": "McMinnville",
            "state": "OR",
            "postal_code": "971284825",
            "country_code": "US",
            "telephone_number": "503-895-0934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CHRYSTAL",
        "middle_name": "JEAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-29",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline A Elliott Vermeer, QMHA, MENTAL HEALTH
• Jude Regan Elliott, CPO
• Sean C Elliott, ANP
• Jamie Lynn Ellis - Wittenhagen, D.O.
• Carilyn Claire Ellis, PSYD, MSCP
• Jordyn R Ellis, CHW
• Katelynn Anne Ellis
• Robin Ellison
• William Blount Ellison III, MD
• Joshua Elliston, BS

• Addiction (Substance Use Disorder) Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.