=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811358096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYRA A LITTRELL LMHC, LCAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2016
-----------------------------------------------------
Last Update Date | 01/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 517 AMVETS DR
-----------------------------------------------------
City | NORTH VERNON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47265-1616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-718-1606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 94
-----------------------------------------------------
City | SCIPIO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47273-0094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-592-8698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 87001648A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 39003485A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------