Provider Demographics
NPI:1265112387
Name:SPREWELL, KYRSTEN
Entity type:Individual
Prefix:
First Name:KYRSTEN
Middle Name:
Last Name:SPREWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 FLEETWOOD CIR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-2500
Mailing Address - Country:US
Mailing Address - Phone:678-457-4927
Mailing Address - Fax:
Practice Address - Street 1:2320 PASEO DEL PRADO STE B208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4332
Practice Address - Country:US
Practice Address - Phone:702-685-0877
Practice Address - Fax:702-749-5922
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW008145101YM0800X
NV10897-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health