Provider Demographics
NPI:1366113896
Name:CROSBY, TERESA MARIE (BSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:CROSBY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:3111 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-8127
Mailing Address - Country:US
Mailing Address - Phone:810-985-8900
Mailing Address - Fax:
Practice Address - Street 1:19800 HALL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5318
Practice Address - Country:US
Practice Address - Phone:855-996-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2025-06-18
Deactivation Date:2024-09-14
Deactivation Code:
Reactivation Date:2025-06-11
Provider Licenses
StateLicense IDTaxonomies
MI6851118838104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker