Individual
MRS. CRYSTAL L ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP-T
Contact information
Practice address
218 N OAK ST STE B, COLVILLE, WA 99114-2968
(509) 684-5867
(509) 684-1925
Mailing address
218 N OAK ST STE B, COLVILLE, WA 99114-2968
(509) 684-5867
(509) 684-1925
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61154536
WA
376K00000X
Nurse's Aide
CM60865562
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/17/2020
Last updated
06/07/2021
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