Provider Demographics
NPI:1700487139
Name:MITCHELL, KRISHIYANNA A (CSW)
Entity type:Individual
Prefix:
First Name:KRISHIYANNA
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:KRISSY
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSW
Mailing Address - Street 1:271 W SHORT ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1214
Mailing Address - Country:US
Mailing Address - Phone:859-310-6505
Mailing Address - Fax:
Practice Address - Street 1:271 W SHORT ST
Practice Address - Street 2:SUITE 508
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1214
Practice Address - Country:US
Practice Address - Phone:859-310-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid