Basic Information
| Provider Information | |||||||||
| NPI: | 1366926339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRYSL | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PLMHP, PLADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 W PASEWALK AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025006870 | ||||||||
| FaxNumber: | 4025006871 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 W PASEWALK AVE STE A | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025006870 | ||||||||
| FaxNumber: | 4025006871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2018 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 11666 | NE | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.