Provider Demographics
NPI:1578329777
Name:CRISTY KAY LCSW LLC
Entity Type:Organization
Organization Name:CRISTY KAY LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-956-8844
Mailing Address - Street 1:9494 N GOVERNMENT WAY # 202
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9848
Mailing Address - Country:US
Mailing Address - Phone:208-315-9321
Mailing Address - Fax:
Practice Address - Street 1:9494 N GOVERNMENT WAY # 202
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9848
Practice Address - Country:US
Practice Address - Phone:208-315-9321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty