Provider Demographics
NPI:1336836212
Name:THRASH, KRISTEL HECKMAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEL
Middle Name:HECKMAN
Last Name:THRASH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 ATTALA ROAD 4227
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:MS
Mailing Address - Zip Code:39192-7754
Mailing Address - Country:US
Mailing Address - Phone:601-319-7011
Mailing Address - Fax:
Practice Address - Street 1:5611 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8929
Practice Address - Country:US
Practice Address - Phone:601-939-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1972101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional