Provider Demographics
NPI:1306328166
Name:KAY, CRISTY (LCSW)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:
Last Name:KAY
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 1:9494 N GOVERNMENT WAY # 202
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9848
Mailing Address - Country:US
Mailing Address - Phone:208-315-9321
Mailing Address - Fax:
Practice Address - Street 1:9494 N GOVERNMENT WAY # 202
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9848
Practice Address - Country:US
Practice Address - Phone:208-315-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID400061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical