Healthcare Provider Details

I. General information

NPI: 1912024498
Provider Name (Legal Business Name): KRISTA R. VAVRO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 BROOKS INDUSTRIAL RD STE. A
SHELBYVILLE KY
40065-8154
US

IV. Provider business mailing address

998 BROOKS INDUSTRIAL RD STE. A
SHELBYVILLE KY
40065-8154
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1315
  • Fax: 502-633-1316
Mailing address:
  • Phone: 502-633-1315
  • Fax: 502-633-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0811
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: