Provider Demographics
NPI:1053775072
Name:CRINER, ELIZABETH (SUDP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CRINER
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S 1ST ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3623
Mailing Address - Country:US
Mailing Address - Phone:360-964-4142
Mailing Address - Fax:360-964-4143
Practice Address - Street 1:138 S 1ST ST STE 6
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3623
Practice Address - Country:US
Practice Address - Phone:360-964-4142
Practice Address - Fax:360-964-4143
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60494027101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60494027OtherLICENSE NUMBER