Carl Crockham

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

4325 W Rome Blvd Apt 1184
North Las Vegas, NV 89084-5409

Phone

(702) 561-0866

NPI assigned

Jun 24, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pure Hearts Behavioral Healthcare

  • Community/Behavioral Health Agency
  • North Las Vegas, NV
  • NPI 1891118949
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403568000000",
    "number": "1174938518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4325 W ROME BLVD APT 1184",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890845409",
            "telephone_number": "702-561-0866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4325 W ROME BLVD APT 1184",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890845409",
            "telephone_number": "702-561-0866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKHAM",
        "first_name": "CARL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-24",
        "last_updated": "2014-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crisis Team LLC
• Phylicia Crisp
• Jill Crochet, PHARM-D
• Elnora Crockett
• Keniesha Andrea Crockett
• Ashley Bre'Yun Croft
• Lavern Croft
• Anne Croker
• D'Vesheia Cromwell
• Jana Crook

• Clinical Social Worker in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.