Provider Demographics
NPI:1437355799
Name:KOETJE, KRISTIN LEIGH (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LEIGH
Last Name:KOETJE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 GALLETTI WAY -NNAMHS
Mailing Address - Street 2:BUILDING 8
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431
Mailing Address - Country:US
Mailing Address - Phone:775-467-8061
Mailing Address - Fax:775-688-3386
Practice Address - Street 1:480 GALLETTI WAY -NNAMHS
Practice Address - Street 2:BUILDING 8
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431
Practice Address - Country:US
Practice Address - Phone:775-467-8061
Practice Address - Fax:775-688-3386
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW76011041C0700X
NV7907-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical