Provider Demographics
NPI:1285076919
Name:VITEK, KRYSTA (LCSW)
Entity type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:VITEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRYSTA
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:255 BLUE LAKES BLVD N # 633
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5238
Mailing Address - Country:US
Mailing Address - Phone:208-736-5048
Mailing Address - Fax:
Practice Address - Street 1:601 POLE LINE RD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3035
Practice Address - Country:US
Practice Address - Phone:208-308-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-319591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1558606962Medicaid