MEDICARE: MRS. KRYSTAL KAI BRASS LCSW

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	104100000X	Social Worker	2928-S	NV
2	104100000X	Social Worker	IC-1156	NV
3	1041C0700X	Clinical Social Worker	9087-C	NV

General Provider Information

NPI Number	:	1619245651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRYSTAL KAI BRASS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 752182
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89136-2182
Country	:	US
Telephone Number	:	702-625-5212
Fax Number	:	702-827-0340

Provider Business Practice Location Address
First Line	:	7495 W AZURE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4416
Country	:	US
Telephone Number	:	702-625-5212
Fax Number	:	702-827-0340

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

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	01/03/2022

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