Provider Demographics
NPI:1164847927
Name:KHATIB, KERRI CHRISTINA (LAC,LBSW)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:CHRISTINA
Last Name:KHATIB
Suffix:
Gender:F
Credentials:LAC,LBSW
Other - Prefix:
Other - First Name:CHRISY
Other - Middle Name:
Other - Last Name:KHATIB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC,LBSW
Mailing Address - Street 1:1625 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-1701
Mailing Address - Country:US
Mailing Address - Phone:785-423-0007
Mailing Address - Fax:785-296-0256
Practice Address - Street 1:1625 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-1701
Practice Address - Country:US
Practice Address - Phone:785-423-0007
Practice Address - Fax:785-296-0256
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLAC526101YA0400X
KSLBSW4079104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker