Provider Demographics
NPI:1700498656
Name:DUPRE, KHRYSTAL MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KHRYSTAL
Middle Name:MARIE
Last Name:DUPRE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5067
Mailing Address - Country:US
Mailing Address - Phone:931-820-0210
Mailing Address - Fax:
Practice Address - Street 1:1989 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5067
Practice Address - Country:US
Practice Address - Phone:504-472-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11694171M00000X
TNLSW0000010984104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator