Basic Information
| Provider Information | |||||||||
| NPI: | 1144452319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANKINSHIP | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3360 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972083360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667472455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1830 BICKFORD AVE STE 211 | ||||||||
| Address2: | |||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253165062 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 02/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | LH60277263 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | LW60757043 | WA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LH60757043 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.