Provider Demographics
NPI:1033309901
Name:MUTWIRI, KRISTAL MARIE (MSW/LISW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:MARIE
Last Name:MUTWIRI
Suffix:
Gender:F
Credentials:MSW/LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W MARKET ST FL 5
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4865
Mailing Address - Country:US
Mailing Address - Phone:419-229-2222
Mailing Address - Fax:419-229-2227
Practice Address - Street 1:205 W MARKET ST FL 5
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4865
Practice Address - Country:US
Practice Address - Phone:419-229-2222
Practice Address - Fax:419-229-2227
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33004758A1041C0700X
KY45181041C0700X
OHI00280571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical