Provider Demographics
NPI:1558836551
Name:ROSE, KRYSTIN HEATHER (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:HEATHER
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8687 W SAHARA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5869
Mailing Address - Country:US
Mailing Address - Phone:702-830-9619
Mailing Address - Fax:702-840-1033
Practice Address - Street 1:8687 W SAHARA AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5869
Practice Address - Country:US
Practice Address - Phone:702-830-9619
Practice Address - Fax:702-840-1033
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9093-C1041C0700X
NV8095-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical