Basic Information
| Provider Information | |||||||||
| NPI: | 1619450863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHIPPLE | ||||||||
| FirstName: | KRYSTAL | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ASHCROFT | ||||||||
| OtherFirstName: | KRYSTAL | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | BSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10439 PRAIRIE MOUNTAIN AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891665065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802995483 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6600 W CHARLESTON BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891469001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024374673 | ||||||||
| FaxNumber: | 7024384673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2018 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | NV | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | NV | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | NV | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 171W00000X | NV | N | Other Service Providers | Contractor | 101YP2500X | NV | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.