Provider Demographics
NPI:1669239588
Name:MOUSHON, KRISTEN (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MOUSHON
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 1:514 HIDDEN HILLS WAY # 40391
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1024
Mailing Address - Country:US
Mailing Address - Phone:309-573-8281
Mailing Address - Fax:
Practice Address - Street 1:514 HIDDEN HILLS WAY # 40391
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1024
Practice Address - Country:US
Practice Address - Phone:309-573-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2585871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical