Provider Demographics
NPI:1447797212
Name:RANSOM-SOPER, CRYSTA (LMSW)
Entity Type:Individual
Prefix:
First Name:CRYSTA
Middle Name:
Last Name:RANSOM-SOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 HARTSHORN ST
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1358
Mailing Address - Country:US
Mailing Address - Phone:810-310-0854
Mailing Address - Fax:
Practice Address - Street 1:6627 ROSE ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1262
Practice Address - Country:US
Practice Address - Phone:989-872-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1303751041C0700X
1041C0700X
MI68010999651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical