Telecia Crockett

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

101 E Broadway Ave
Bloomfield, NM 87413-6235

Phone

(505) 330-8220

Fax

(505) 234-7867

NPI assigned

Jan 14, 2021

Last updated

Jan 19, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Locations

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

• Angel Peak Counseling, LLC

  • Mental Health Counselor
  • Bloomfield, NM
  • NPI 1730760943
  NPD
• Sadie L Smith-McDaniel

  dba Angel Peak Counseling

  • Community/Behavioral Health Agency
  • Bloomfield, NM
  • NPI 1649704925
  NPD

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

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1205425170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E BROADWAY AVE",
            "city": "BLOOMFIELD",
            "state": "NM",
            "postal_code": "874136235",
            "telephone_number": "505-330-8220",
            "fax_number": "505-234-7867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E BROADWAY AVE",
            "city": "BLOOMFIELD",
            "state": "NM",
            "postal_code": "874136235",
            "telephone_number": "505-330-8220",
            "fax_number": "505-234-7867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "114 N Behrend Ave",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "NM",
            "postal_code": "874018414",
            "country_code": "US",
            "telephone_number": "505-330-8220",
            "fax_number": "505-234-7867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "TELECIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-14",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristi Coddington, LCSW
• Victoria D. Coe, P.T.
• Cynthia Colson
• Sharon Flora Cooke, LISW
• Brandon Ira Crockett
• Anna Marie Curtis
• Kellen Dean
• Karen Dennis, RN
• Nicole Marie Desouchet, DPT
• Deanna Devore, LMSW

• Community Health Worker in Bloomfield, NM
• Providers in Bloomfield, NM by specialty
• Community Health Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.