Provider Demographics
NPI:1578828554
Name:MOFFIS, KRISTA DENISE (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:DENISE
Last Name:MOFFIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 S. FIRST STREET
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651
Mailing Address - Country:US
Mailing Address - Phone:208-484-7974
Mailing Address - Fax:208-442-8052
Practice Address - Street 1:1224 1ST ST S
Practice Address - Street 2:SUITE 306
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3900
Practice Address - Country:US
Practice Address - Phone:208-484-7974
Practice Address - Fax:208-442-8052
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW 32243104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker