Provider Demographics
NPI:1760623680
Name:KEMP, KRYSTAL JUANISE (LCSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:JUANISE
Last Name:KEMP
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 1:1800 E TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-1938
Mailing Address - Country:US
Mailing Address - Phone:816-404-6301
Mailing Address - Fax:816-404-6318
Practice Address - Street 1:1800 E TRUMAN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-1938
Practice Address - Country:US
Practice Address - Phone:816-404-6301
Practice Address - Fax:816-404-6318
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
KS055751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker