CRYSTAL LEE COBURN (NPI# 1366099004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366099004 |
| Entity Type | Individual |
| Full Name | CRYSTAL LEE COBURN |
| Practice Address |
8915 Sw Center St Tigard OR 97223-6307 |
| Practice Telephone | 5037263690 |
| Mailing Telephone | 5037263690 |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2020-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 805 Se 151st Ave, Portland, OR 972332916 | 9712717270 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922551555 | Crystal Coburn | Technician, Other | 41521 W 11 Mile Rd, Novi, MI 48375-1803 | 2016-08-01 |
| Street Address |
8915 SW CENTER ST |
| City | TIGARD |
| State | OR |
| Zip Code | 97223-6307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265595664 | Luke-dorf | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2006-12-18 |
| 1710587357 | Jo Fish | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-10-30 |
| 1750981668 | Mason Lorenzo Pfeifer | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-10-29 |
| 1326645060 | Hernando Hernandez Jr. | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-10-06 |
| 1053928473 | Lori Jean Sherlock | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-09-29 |
| 1508472150 | William Van Sant | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-09-18 |
| 1750996112 | Ali Janelle Swetland | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-09-12 |
| 1124632526 | Cloey Layton | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-09-02 |
| 1770197501 | Christina Marie Herrera | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-08-31 |
| 1396358289 | Alisia Foster | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-08-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760042618 | Tess Ivie Manso | Counselor | 8915 Degrees Center St, Tigard, OR 97223 | 2019-06-13 |
| 1780141804 | Amybrunermd LLC | Obstetrics & Gynecology | 6958 Sw Varns Street, Portland, OR 97223 | 2019-02-25 |
| 1417425034 | Patience Marie Rutto | Counselor | 8915 Sw Center Streret, Tigard, OR 97223 | 2018-11-13 |
| 1871089581 | Marina E Menegol | Behavioral Analyst | Center for Social Dynamics, 9115 Southwest Oleson Rd. Ste. 100, Portland, OR 97223 | 2018-07-05 |
| 1215423165 | Katherine Virginia Eichner | Psychologist | 9860 Sw Hall Blvd Ste B, Tigard, OR 97223 | 2018-07-03 |
| 1043717390 | Rayna Donnelly | Physician Assistant | 9735 Sw Shady Ln Ste 102, Tigard, OR 97223 | 2018-04-11 |
| 1376059725 | Kaylie Marilyn Reyes | Behavioral Analyst | 9115 Sw Oleson Road, Portland, OR 97223 | 2017-12-21 |
| 1841704004 | Kathleen Terrell Taylor | Occupational Therapist | 7320 Sw Hunziker, Suite 203, Tigard, OR 97223 | 2017-11-27 |
| 1487163036 | Susie Riess | Counselor | 10763 Sw Greenburg Road, Suite 100, Tigard, OR 97223 | 2017-09-27 |
| 1043731243 | Tam Nguyen | Optometrist | 8795 Sw Scholls Ferry Rd Ste 100, Tigard, OR 97223 | 2017-06-28 |
| Find all providers in zip 97223 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902364755 | Melissa Long | Peer Specialist | 7110 Sw Fir Loop Ste 160, Tigard, OR 97223-8031 | 2019-03-11 |
| 1154708667 | Leon Mccoy | Peer Specialist | 7582 Sw Hunziker St, 44, Tigard, OR 97223-8222 | 2015-05-04 |
| 1457979585 | Erica Rae Wasco | Peer Specialist | 7110 Sw Fir Loop Ste 160, Tigard, OR 97223-8031 | 2020-07-06 |
| 1275151300 | Alina Pj Cowan | Peer Specialist | 7110 Sw Fir Loop Ste 160, Tigard, OR 97223-8031 | 2020-07-06 |
| 1316586498 | Melissa Renee Mills | Peer Specialist | 7110 Sw Fir Loop Ste 160, Tigard, OR 97223-8031 | 2020-01-06 |
| 1396208237 | Julie B Berry | Peer Specialist | 7110 Sw Fir Loop Ste 160, Tigard, OR 97223-8031 | 2019-04-08 |
| 1609336148 | Heidi Lynn Miles | Peer Specialist | 7110 Sw Fir Loop Ste 160, Tigard, OR 97223-8031 | 2019-03-21 |
| 1942778139 | Holly Blalack | Peer Specialist | 12540 Sw Main St Ste 202, Tigard, OR 97223-6198 | 2018-11-06 |
| 1003319765 | Fletcher Nash | Peer Specialist | 8915 Sw Center St, Tigard, OR 97223-6307 | 2018-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
| 1578162145 | Kenneth Branson | Peer Specialist | 389 Sw Scalehouse Ct Ste 130, Bend, OR 97702-3241 | 2020-10-23 |
| 1962000554 | Dawn Marks | Peer Specialist | 21440 Se Stark St, Gresham, OR 97030-2024 | 2020-10-15 |
| 1679188080 | Michelle Marie Bunkers | Peer Specialist | 20517 Jacklight Ln, Bend, OR 97702-2971 | 2020-09-11 |
| 1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
| 1528677820 | Charice Monette | Peer Specialist | 4151 Kacey Cir Ne, Salem, OR 97305-4504 | 2020-07-23 |
| 1841810322 | Ariana Lee May | Peer Specialist | 1601 Olive St Apt 1008, Eugene, OR 97401-3985 | 2020-04-24 |
| 1982237236 | Jessica M Montoya | Peer Specialist | 235 Se Knowledge St, Prineville, OR 97754-2362 | 2020-02-14 |
| 1134752579 | Lisa Kennedy | Peer Specialist | 132 Ne B St # 24, Grants Pass, OR 97526-2114 | 2020-02-13 |
| 1730711953 | Michael Anthony Duran | Peer Specialist | 1515 Hill St Se, Albany, OR 97322-6715 | 2020-02-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.