Provider Demographics
NPI:1245244821
Name:GATHING, KRISTY (LSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:GATHING
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:4000 E CHARLESTON BLVD STE B230
Mailing Address - Street 2:LAS VEGAS
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6682
Mailing Address - Country:US
Mailing Address - Phone:702-968-4009
Mailing Address - Fax:702-968-5050
Practice Address - Street 1:4000 E CHARLESTON BLVD STE B230
Practice Address - Street 2:LAS VEGAS
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6682
Practice Address - Country:US
Practice Address - Phone:702-968-4009
Practice Address - Fax:702-968-5050
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4502S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker