Provider Demographics
NPI:1922384692
Name:WORKING DRURY, KRYSTLE M (LCSW)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:M
Last Name:WORKING DRURY
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 1:4466 STATE ROUTE 261 STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2832
Mailing Address - Country:US
Mailing Address - Phone:812-490-2100
Mailing Address - Fax:
Practice Address - Street 1:4466 STATE ROUTE 261 STE 1
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2832
Practice Address - Country:US
Practice Address - Phone:812-490-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6211101YM0800X
IN33006405A1041C0700X
IN34006969A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34006969AOtherLCSW
KY7100514370Medicaid
KY254098OtherLCSW