Krystal Lightle, QMHA-II, CADC-R

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

22-QMHA-II-000041 Issued in OR

Practice address

4080 Reed Rd SE Ste 150
Salem, OR 97302-1335

Phone

(503) 581-1732

Fax

(541) 344-4780

NPI assigned

Sep 22, 2022

Last updated

Sep 22, 2022By 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 1

Addresses

Electronic endpoints 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Shangri-la Corporation

  dba Shangri-La Corporation

  • Community/Behavioral Health Agency
  • Eugene, OR
  • NPI 1053858993
  NPD (past)
• The Shangri-la Corporation

  dba Shangri-La Corporation

  • Community/Behavioral Health Agency
  • Salem, OR
  • NPI 1578000758
  NPD (past)

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

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1841913936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1502",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974401502",
            "telephone_number": "541-344-1121",
            "fax_number": "541-344-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4080 REED RD SE STE 150",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973021335",
            "telephone_number": "503-581-1732",
            "fax_number": "541-344-4780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "398 High St",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974012310",
            "country_code": "US",
            "telephone_number": "541-344-1121 x101",
            "fax_number": "541-344-4780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIGHTLE",
        "first_name": "KRYSTAL",
        "credential": "QMHA-II, CADC-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": "22-QMHA-II-000041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krystal.lightle@shangrila-or.org",
            "affiliation": "N",
            "endpointDescription": "Professional Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "4080 Reed Rd SE Ste 150",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973021335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Case Manager/Care Coordinator in Salem, OR
• Providers in Salem, OR by specialty
• Case Manager/Care Coordinator in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.