Provider Demographics
NPI:1306911656
Name:SUMINSKI, KRISTIN KAY (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KAY
Last Name:SUMINSKI
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 MORGAN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-3424
Mailing Address - Country:US
Mailing Address - Phone:319-249-5777
Mailing Address - Fax:
Practice Address - Street 1:1626 MORGAN ST STE 4
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3424
Practice Address - Country:US
Practice Address - Phone:319-249-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00839101YM0800X
IL178005136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA107314000OtherIOWA PLAN