Crystal Dawn Ellis, LSCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4761 Issued in KS

Practice address

5399 Hwy 43 BLDG B
Joplin, MO 64804-4927

Phone

(913) 444-9756

NPI assigned

Oct 11, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Crystal Dawn Witty Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1349913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1811249048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5399 HWY 43 BLDG B",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648044927",
            "telephone_number": "913-444-9756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5399 HWY 43 BLDG B",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648044927",
            "telephone_number": "913-444-9756"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4012 Five Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Seneca",
            "state": "MO",
            "postal_code": "648658516",
            "country_code": "US",
            "telephone_number": "620-423-4775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2512 Crawford Ave",
            "address_purpose": "LOCATION",
            "city": "Parsons",
            "state": "KS",
            "postal_code": "673572529",
            "country_code": "US",
            "telephone_number": "913-444-9756",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "518 C St SE",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "OK",
            "postal_code": "743548117",
            "country_code": "US",
            "telephone_number": "913-444-9756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CRYSTAL",
        "middle_name": "DAWN",
        "credential": "LSCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-11",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "21113",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2022021360",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "4761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "16130914",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "WITTY",
            "middle_name": "DAWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alex Elliott
• Elijah Patrick Elliott, DO
• Josephine E Elliott
• Ren Avery Elliott, LPC
• Christina Ellis
• Spencer L Ellis, CASAC
• Virgil Bennett Ellis
• Carolyn Elmborg, CRNA
• Dallin Daniel Elmer, DO
• Abbey Elmore

• Clinical Social Worker in Joplin, MO
• Providers in Joplin, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.