Provider Demographics
NPI:1053846824
Name:KIRBY, KRYSTAL (LICSW, LIMHP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LICSW, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22571
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68542-2571
Mailing Address - Country:US
Mailing Address - Phone:402-858-7774
Mailing Address - Fax:
Practice Address - Street 1:4747 PIONEERS BLVD STE 10D
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5313
Practice Address - Country:US
Practice Address - Phone:402-858-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1936101YM0800X
NE4948101YP2500X
NE18511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty