Provider Demographics
NPI:1689714651
Name:MIR, KRISTEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:ZAHRADNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2514 1/2 WESLEY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1754
Mailing Address - Country:US
Mailing Address - Phone:423-529-0385
Mailing Address - Fax:423-414-2699
Practice Address - Street 1:2514 1/2 WESLEY ST STE 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1754
Practice Address - Country:US
Practice Address - Phone:423-529-0385
Practice Address - Fax:423-414-2699
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW0000006858104100000X
TNLSW00000052551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker