Individual provider Active NPI

Tiara Nicole Crutchfield

  • Social Worker
  • Southfield, MI
National Provider Identifier
1760151765
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
17320 W 12 Mile Rd
Southfield, MI 48076-2100
Phone
(248) 727-3456
NPI assigned
Sep 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Professional Counselor 101YP2500X
Social Worker 104100000X Primary

Addresses

Primary practice location

17320 W 12 Mile Rd
Southfield, MI 48076-2100

Mailing address

29780 Wildbrook Dr
Southfield, MI 48034-7615
Phone (248) 974-3618

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pcerecords.essmichigan@direct.mihin.net Easterseals MORC Health Care, Inc.

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Richard Kneip, PH.D., P.C. Past Accepting new patients
Southfield Mental Health Associates PC PastSince Sep 23, 2021 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1760151765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29780 WILDBROOK DR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480347615",
            "telephone_number": "248-974-3618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17320 W 12 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762100",
            "telephone_number": "248-727-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUTCHFIELD",
        "first_name": "TIARA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-13",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pcerecords.essmichigan@direct.mihin.net",
            "affiliation": "Y",
            "affiliationName": "Easterseals MORC Health Care, Inc.",
            "address_1": "2399 E Walton Blvd",
            "city": "Auburn Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483261955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.

Verify at the official NPI Registry.