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General NPI Number Information
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NPI Number | 1689714651
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Entity Type | Individual
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Provider Name | KRISTEN MIR LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 02/03/2019
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Provider Practice Location Address
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Address Line | 2514 1/2 WESLEY ST STE 2
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1754
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Country | US
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Telephone | 423-529-0385
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Fax | 423-414-2699
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Provider Business Mailing Address
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Address Line | 2514 1/2 WESLEY ST STE 2
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1754
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Country | US
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Telephone | 423-529-0385
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Fax | 423-414-2699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | CSW0000006858
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW0000005255
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License Number State | TN
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