Provider Demographics
NPI:1619245651
Name:BRASS, KRYSTAL KAI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:KAI
Last Name:BRASS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 752182
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89136-2182
Mailing Address - Country:US
Mailing Address - Phone:702-625-5212
Mailing Address - Fax:702-827-0340
Practice Address - Street 1:7495 W AZURE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4416
Practice Address - Country:US
Practice Address - Phone:702-625-5212
Practice Address - Fax:702-827-0340
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2928-S104100000X
NVIC-1156104100000X
NV9087-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker