Crystal A Smith, IMFT, LCSW, IBHC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149014748 Issued in IL

Practice address

10448 S Pulaski Rd
Suite 4
Oak Lawn, IL 60453-4895

Phone

(312) 834-3697

NPI assigned

Aug 22, 2011

Last updated

Jan 5, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• International Behaviorial Health Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Health Readiness Resources Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Honolulu, HI
  • NPI 1669295937

  Professional

  NPD Authorized official
• International Behavioral Health

  • Clinical Social Worker
  • Oak Lawn, IL
  • NPI 1225310865
  Authorized official Same address or phone

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

{
    "created_epoch": "1313971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578182400000",
    "number": "1871873893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1342 W TAYLOR ST UNIT 302",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074705",
            "telephone_number": "312-554-9934",
            "fax_number": "877-211-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10448 S PULASKI RD",
            "address_2": "SUITE 4",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604534895",
            "telephone_number": "312-834-3697"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Ala Moana Blvd",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968134920",
            "country_code": "US",
            "telephone_number": "877-211-1870 x808",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "275 Farenholt Ave",
            "address_purpose": "LOCATION",
            "city": "Tamuning",
            "state": "GU",
            "postal_code": "969133217",
            "country_code": "US",
            "telephone_number": "877-211-1170 x671",
            "fax_number": "877-211-1870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CRYSTAL",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "IMFT, LCSW, IBHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-22",
        "last_updated": "2020-01-05",
        "certification_date": "2020-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GU",
            "license": "LPC-125",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "LCSW-4503",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW019175",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149014748",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GU",
            "license": "GU-125",
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "GU",
            "license": "IBHC",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8367001",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.internationalbh.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10448 S Pulaski Rd",
            "address_2": "suite 4",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604534895",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "INTERNATIONAL",
            "last_name": "BEHAVIORIAL HEALTH",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Alison Kyle Small, OTR/L
• John Thomas Smetona, M.D.
• Benjamin Smith-Donald
• Allison Marie Smith, MS
• Christopher J Smith, MD
• Jelani Smith, MD
• Katrina Nichele Smith, MOT, OTR/L
• Lauren Smith, FNP
• Madelyn Smith, LCSW
• Michael Smith, DMD

• Clinical Social Worker in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2020; 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.