Provider Demographics
NPI:1750655999
Name:SHREVE, KRYSTAL RENEE (LMSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:RENEE
Last Name:SHREVE
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 1:200 N CALEDONIA DR
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-8844
Mailing Address - Country:US
Mailing Address - Phone:989-729-4848
Mailing Address - Fax:989-729-4849
Practice Address - Street 1:200 N CALEDONIA DR
Practice Address - Street 2:SUITE 1460
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-8844
Practice Address - Country:US
Practice Address - Phone:989-729-4848
Practice Address - Fax:989-729-4849
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010957961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical