Provider Demographics
NPI:1174146500
Name:SERPAS, KRYSTAL (LMSW)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:SERPAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:STEENS
Mailing Address - State:MS
Mailing Address - Zip Code:39766-8526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86 MITCHELL DR
Practice Address - Street 2:
Practice Address - City:STEENS
Practice Address - State:MS
Practice Address - Zip Code:39766-8526
Practice Address - Country:US
Practice Address - Phone:662-497-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health