Provider Demographics
NPI:1689271843
Name:SEARS, KRYSTLE MAY (LMSW)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:MAY
Last Name:SEARS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:
Other - Last Name:RABIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1550 N CRESTMONT DR STE A
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2177
Mailing Address - Country:US
Mailing Address - Phone:208-288-4200
Mailing Address - Fax:
Practice Address - Street 1:1550 N CRESTMONT DR STE A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2177
Practice Address - Country:US
Practice Address - Phone:208-288-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health