Healthcare Provider Details

I. General information

NPI: 1841430956
Provider Name (Legal Business Name): KRISTY LEE NUTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTY LEE KAST LCSW

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 SCHOOL ST
STEUBENVILLE OH
43952-7063
US

IV. Provider business mailing address

101 PEMBROKE CT
GREENSBURG PA
15601-6404
US

V. Phone/Fax

Practice location:
  • Phone: 724-396-1510
  • Fax: 724-972-4627
Mailing address:
  • Phone: 724-396-1510
  • Fax: 724-972-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00943132
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.0800205
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020016
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: