Provider Demographics
NPI:1750847422
Name:MATTI, CRYSTAL (LMSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MATTI
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 1:38600 VAN DYKE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1171
Mailing Address - Country:US
Mailing Address - Phone:586-413-7221
Mailing Address - Fax:
Practice Address - Street 1:38600 VAN DYKE AVE STE 100
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1171
Practice Address - Country:US
Practice Address - Phone:586-413-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011036751041C0700X
MI6801109390104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical