Crystal L Clark, RC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

260 E 11TH Ave
Eugene, OR 97401-3247

Phone

(541) 484-4428

Fax

(541) 484-7212

NPI assigned

Oct 30, 2008

Last updated

Mar 17, 2018By 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 OR

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 1

Specialty

Mental Health Counselor

Education

Other, 2009

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Solution Focused Therapy

  • Clinic/Center
  • Newport, OR
  • NPI 1104416619
  Medicare reassignment NPD

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

{
    "created_epoch": "1225324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1699928937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 W 11TH AVE STE 200",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974023871",
            "telephone_number": "541-686-2688",
            "fax_number": "541-345-7605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 E 11TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013247",
            "telephone_number": "541-484-4428",
            "fax_number": "541-484-7212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9706 4th Ave NE",
            "address_2": "Sound Mental Health, Suite 303",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981152157",
            "country_code": "US",
            "telephone_number": "206-302-2900",
            "fax_number": "206-302-2910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CRYSTAL",
        "middle_name": "L",
        "credential": "RC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-30",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "RC60018186",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Shannon Clark, LPC-ASSOCIATE R7809
• Breanne Ariel Clark
• Caitlin Alexandra Clark, BA, CADC I
• Camm D. Clark, LCSW
• Christina Clark
• Eric Franklin Clark
• Georganne M. Clark, C.P.M.
• Harold Ulice Clark, ADDICTIONS THERAPIST
• Jeremy Joseph Clark
• Jill R Clark, LCSW

• Mental Health Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.