Samuel Crockett, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178-021245 Issued in IL

Practice address

124 N Sangamon St
Chicago, IL 60607-2202

Phone

(312) 226-7984

Fax

(312) 980-0482

NPI assigned

Apr 25, 2025

Sex

Male

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: london.crockett.p1@direct.hcenter.nextgenshare.com

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.

• McDermott Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1457004046
  NPD

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

{
    "created_epoch": "1745539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745539200000",
    "number": "1699563262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "932 W WASHINGTON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072217",
            "telephone_number": "312-226-7984",
            "fax_number": "312-980-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 N SANGAMON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072202",
            "telephone_number": "312-226-7984",
            "fax_number": "312-980-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "SAMUEL",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-25",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178-021245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Croce, MD
• Felicia Crocker
• Crockett Counseling PLLC
• Devin Crockett, DMD
• Martha Antina Crockett
• Sonja Crockett
• Melinda A Croes, LCSW
• Fanai Croff
• Heather Croft, DPT
• Mallory Croft

• Professional Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; 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.