Crystal L Harris, MSSA, LSW,LICDC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

S.1701473 Issued in OH

Practice address

4269 Pearl Rd
Cleveland, OH 44109-4234

Phone

(216) 431-4131

NPI assigned

Oct 27, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Orca House

  • Substance Abuse Rehabilitation Facility
  • Cleveland, OH
  • NPI 1851470603
  NPD (past)

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

{
    "created_epoch": "1509062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1831601061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11906 SUMMERLAND AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441115059",
            "telephone_number": "216-450-9526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4269 PEARL RD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441094234",
            "telephone_number": "216-431-4131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1909 E 89th St",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441062007",
            "country_code": "US",
            "telephone_number": "216-231-3772 x116",
            "fax_number": "216-231-7540",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3500 Carnegie Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441152641",
            "country_code": "US",
            "telephone_number": "440-260-8300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "CRYSTAL",
        "middle_name": "L",
        "credential": "MSSA, LSW,LICDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-27",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "1701473",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "130671",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1701473",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "S.1701473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Mikeal Harris, MD
• Camille Harris
• Chane Harris
• Charmane Harris
• Colette Harris, MD, MPH
• Daisetta Harris, QMHS
• Danelle Harris
• David Jinn Harris, M.D.
• Davonte D Harris
• Delores Elene Joy Harris, RN

• Counselor in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; 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.