Provider Demographics
NPI:1922419134
Name:WESCOTT, KRISTY M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:M
Last Name:WESCOTT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:MATYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:36780 N YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5603
Mailing Address - Country:US
Mailing Address - Phone:510-881-3608
Mailing Address - Fax:
Practice Address - Street 1:650 E INDIAN SCHOOL RD BLDG 31
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
AZLMSW-21164104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker