Active NPI
Crystal Ponce
- Clinical Social Worker
- Las Vegas, NV
National Provider Identifier
1174968762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11119M
- Practice address
- 3965 E Owens Ave Ste 180
Las Vegas, NV 89110-7034 - Phone
- (702) 331-5983
- NPI assigned
- May 8, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11119M | NV | Primary |
Addresses
Primary practice location
3965 E Owens Ave Ste 180
Las Vegas, NV 89110-7034
Mailing address
1316 W Adams Ave
Las Vegas, NV 89106-2842
Phone (702) 981-2095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11119M | NV | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Self Sufficiency Behavioral Health LLC | Current | Accepting new patients | |
| Clear Minds LLC | Past | Accepting new patients |
Locations
3965 E Owens Ave
Ste 180
Las Vegas, NV 89110
Phone (702) 331-5983
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Las Vegas, NV
- NPI 1629556261
-
- Community/Behavioral Health Agency
- Las Vegas, NV
- NPI 1518383892
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712620800000",
"number": "1174968762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1316 W ADAMS AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891062842",
"telephone_number": "702-981-2095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3965 E OWENS AVE STE 180",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891107034",
"telephone_number": "702-331-5983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONCE",
"first_name": "CRYSTAL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-08",
"last_updated": "2024-04-09",
"certification_date": "2024-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NV",
"license": "11119M",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.