Individual provider Active NPI

Eric Ty Crutchfield, LCSW

  • Clinical Social Worker
  • Benton, AR
National Provider Identifier
1902011000
Registry record updated Jan 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2545-C Issued in AR
Practice address
1502 Mary Kay Ave
Benton, AR 72015
Phone
(501) 315-3344
NPI assigned
May 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2545-C AR Primary

Addresses

Primary practice location

1502 Mary Kay Ave
Benton, AR 72015

Mailing address

PO Box 1589
Benton, AR 72018-1589
Phone (501) 315-3344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110118000728 AR Practitioner - Clinical Social Worker 1951590280 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2545-CARMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Counseling Clinic, Inc Clinical CurrentSince Oct 28, 2017 Accepting new patients
Counseling Clinic, Inc. CurrentSince Oct 28, 2017 Accepting new patients

Locations

110 Pearson
Benton, AR 72015
Phone (501) 315-4224

310 Whittington Ave
Hot Springs National Park, AR 71901
Phone (501) 623-3477

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": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296000000000",
    "number": "1902011000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1589",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720181589",
            "telephone_number": "501-315-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 MARY KAY AVE",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "72015",
            "telephone_number": "501-315-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUTCHFIELD",
        "first_name": "ERIC",
        "middle_name": "TY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-11",
        "last_updated": "2011-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "2545-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

Verify at the official NPI Registry.