Provider Demographics
NPI:1851528087
Name:WITTHAUS, KRYSTAL L (LCSW)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:L
Last Name:WITTHAUS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:HERMANN
Mailing Address - State:MO
Mailing Address - Zip Code:65041-0019
Mailing Address - Country:US
Mailing Address - Phone:573-486-1193
Mailing Address - Fax:573-486-0910
Practice Address - Street 1:123 BAVARIAN HILLS PLZ
Practice Address - Street 2:
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041-1613
Practice Address - Country:US
Practice Address - Phone:573-486-2118
Practice Address - Fax:573-486-3533
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080280211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical