JERRY CROCKRELL (NPI# 1245799378) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1245799378 |
Entity Type | Individual |
Full Name | JERRY CROCKRELL |
Practice Address |
411 W Division St Manteno IL 60950-1065 |
Mailing Address |
136 N Arbor Trl Park Forest IL 60466-2604 |
Practice Telephone | 8154325241 |
Mailing Telephone | 7085133494 |
Enumeration Date | 2019-03-18 |
Last Update Date | 2020-03-17 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
Street Address |
411 W DIVISION ST |
City | MANTENO |
State | IL |
Zip Code | 60950-1065 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194967786 | Margaret Garay Sullivan | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2009-03-30 |
1831729474 | Kenzie Taff | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2020-01-23 |
1134759954 | Emily Subach | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2020-01-21 |
1770113896 | Kayleigh Kastelein | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2020-01-16 |
1639734379 | Iroquois Mental Health Center | Community/Behavioral Health | 411 W Division St, Manteno, IL 60950-1065 | 2019-05-08 |
1730641077 | Russell Allee | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2019-04-04 |
1700348760 | Emily Valentine | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2019-04-01 |
1255802732 | Michele Forsythe | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-10 |
1669942413 | Helen Riberdy | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-04 |
1225508062 | Brian Finkelstein | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-04 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710344338 | Specialized Assistance Services, Nfp | Clinic/Center | 333 W Evergreen St, Manteno, IL 60950 | 2016-01-27 |
1588004667 | Nexus Family Healing | Residential Treatment Facility, Emotionally Disturbed Children | 175 Evergreen, Manteno, IL 60950 | 2013-07-03 |
1649610841 | Nexus Family Healing | Residential Treatment Facility, Emotionally Disturbed Children | 325 Hemlock, Manteno, IL 60950 | 2013-07-02 |
1811337280 | Nexus Family Healing | Residential Treatment Facility, Emotionally Disturbed Children | 215 Hemlock, Manteno, IL 60950 | 2013-07-01 |
1407296981 | Nexus Family Healing | Residential Treatment Facility, Emotionally Disturbed Children | 365 Hemlock, Manteno, IL 60950 | 2013-06-28 |
1760822142 | Nexus Family Healing | Residential Treatment Facility, Emotionally Disturbed Children | 185 Chestnut, Manteno, IL 60950 | 2013-06-28 |
1598105975 | Nexus Family Healing | Residential Treatment Facility, Emotionally Disturbed Children | 280 Ironwood, Manteno, IL 60950 | 2013-06-28 |
1942640339 | Nexus Family Healing | Residential Treatment Facility, Emotionally Disturbed Children | 360 Ironwood, Manteno, IL 60950 | 2013-06-28 |
1215377692 | Nexus Family Healing | Residential Treatment Facility, Emotionally Disturbed Children | 110 Evergreen, Manteno, IL 60950 | 2013-06-28 |
1972862787 | Karl A Keller | Dentist | 312 W. Division, Manteno, IL 60950 | 2012-05-14 |
Find all providers in zip 60950 |
Taxonomy Code | 101YA0400X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Counselor |
Specialization | Addiction (Substance Use Disorder) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730641077 | Russell Allee | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2019-04-04 |
1700348760 | Emily Valentine | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2019-04-01 |
1255802732 | Michele Forsythe | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-10 |
1669942413 | Helen Riberdy | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-04 |
1225508062 | Brian Finkelstein | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-04 |
1467922211 | Darrell Donovan | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-04 |
1609346451 | Lance Mccann | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-04 |
1508336546 | Gregory Jen | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-03 |
1326518366 | Kathleen Lund | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-03 |
1073083010 | Reyna Hammerlund | Counselor | 411 W Division St, Manteno, IL 60950-1065 | 2018-12-03 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.