Active NPI
Charles Crockett, MA, AMFT
- Marriage & Family Therapist
- Lafayette, CA
National Provider Identifier
1407601206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 142087
- Practice address
- 978 2ND St Ste 200
Lafayette, CA 94549-4545 - Phone
- (925) 240-3620
- NPI assigned
- Apr 23, 2024
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 142087 | CA | Primary |
Addresses
Primary practice location
978 2ND St Ste 200
Lafayette, CA 94549-4545
Mailing address
3190 Oak Rd Apt 220
Walnut Creek, CA 94597-7763
Phone (707) 483-8392
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 142087 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713830400000",
"number": "1407601206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3190 OAK RD APT 220",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945977763",
"telephone_number": "707-483-8392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "978 2ND ST STE 200",
"city": "LAFAYETTE",
"state": "CA",
"postal_code": "945494545",
"telephone_number": "925-240-3620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCKETT",
"first_name": "CHARLES",
"credential": "MA, AMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-23",
"last_updated": "2024-04-23",
"certification_date": "2024-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "142087",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.