Provider Demographics
NPI:1407571813
Name:CRABTREE, THOMAS RICKSON
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICKSON
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 GOLFSIDE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1145
Mailing Address - Country:US
Mailing Address - Phone:124-870-7553
Mailing Address - Fax:
Practice Address - Street 1:444 N HEWITT RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1844
Practice Address - Country:US
Practice Address - Phone:124-870-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician