MEDICARE: KRISTEN SEARCY LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LMSW7029T	AZ

General Provider Information

NPI Number	:	1174194195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN SEARCY LMSW

Provider Business Mailing Address
First Line	:	2608 N RICHLAND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1034
Country	:	US
Telephone Number	:	818-231-5747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 N RICHLAND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1034
Country	:	US
Telephone Number	:	818-231-5747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	07/09/2021

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