Provider Demographics
NPI:1609296615
Name:MCCUNE, KRISTI (LCSW, QMHP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:LCSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HIGHWAY 95A, SUITE H801
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408
Mailing Address - Country:US
Mailing Address - Phone:775-575-6191
Mailing Address - Fax:
Practice Address - Street 1:415 HIGHWAY 95A
Practice Address - Street 2:SUITE H801
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408
Practice Address - Country:US
Practice Address - Phone:775-575-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR107761041C0700X
104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR223354Medicaid