Provider Demographics
NPI:1053558239
Name:STACHERA, CRYSTAL (LMFT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:STACHERA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 SW 105TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5488
Mailing Address - Country:US
Mailing Address - Phone:971-200-1966
Mailing Address - Fax:971-754-4141
Practice Address - Street 1:6800 SW 105TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5488
Practice Address - Country:US
Practice Address - Phone:971-200-1966
Practice Address - Fax:971-754-4141
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0898106H00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500740069Medicaid