Provider Demographics
NPI:1912024498
Name:VAVRO, KRISTA R (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:R
Last Name:VAVRO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 BROOKS INDUSTRIAL RD
Mailing Address - Street 2:STE. A
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8154
Mailing Address - Country:US
Mailing Address - Phone:502-633-1315
Mailing Address - Fax:502-633-1316
Practice Address - Street 1:998 BROOKS INDUSTRIAL RD
Practice Address - Street 2:STE. A
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8154
Practice Address - Country:US
Practice Address - Phone:502-633-1315
Practice Address - Fax:502-633-1316
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY392069OtherBLUE CROSS BLUE SHIELD
KY7100285210Medicaid
KYVAVROKRSOtherCORPHEALTH AND HUMANA
KY337858OtherMHN
KY22017289OtherCIGNA
KY730320000OtherMAGELLAN HEALTH