Healthcare Provider Details

I. General information

NPI: 1922384692
Provider Name (Legal Business Name): KRYSTLE M WORKING DRURY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 06/07/2020
Certification Date: 06/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4466 STATE ROUTE 261 STE 1
NEWBURGH IN
47630-2832
US

IV. Provider business mailing address

4466 STATE ROUTE 261 STE 1
NEWBURGH IN
47630-2832
US

V. Phone/Fax

Practice location:
  • Phone: 812-490-2100
  • Fax:
Mailing address:
  • Phone: 812-490-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6211
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33006405A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006969A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: