Mattie N Crockett, LPC, MHSP

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4912 Issued in TN

Practice address

1536 Bridgewater LN Ste 104
Kingsport, TN 37660-4103

Phone

(423) 534-7824

NPI assigned

May 13, 2021

Last updated

Aug 14, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.mattiecrockett@148560.advancedmd-direct.com

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.

• Clinical & Forensic Consultation, LLC

  dba Thriveworks

  • Professional Counselor
  • Thompsons Station, TN
  • NPI 1790106979
  NPD
• Cedars Counseling Inc

  • Professional Counselor
  • Murfreesboro, TN
  • NPI 1811392285
  NPD (past)

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1952975005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LARKSPUR DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376606225",
            "telephone_number": "276-639-5676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 BRIDGEWATER LN STE 104",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604103",
            "telephone_number": "423-534-7824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "MATTIE",
        "middle_name": "N",
        "credential": "LPC, MHSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-13",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "4912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC-MHSP",
            "identifier": "4912",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amylyn Lane Crawford, MD
• John D. Creasy, M.D.
• Lyndsey McKay Creech
• Mollie Creel, LCSW
• Lorie Ann Crigger
• Steven Croghan, NP
• Ryan Patrick Cronin, DO
• Audrey B Cross, FNP
• Kyle K Cross
• Terri Jeanne Cross, MA

• Professional Counselor in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Professional Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 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.