Provider Demographics
NPI:1609223809
Name:LATHROP, KIRA KRISTINA (MA, LPC, DBTC)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:KRISTINA
Last Name:LATHROP
Suffix:
Gender:F
Credentials:MA, LPC, DBTC
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:SKAGWAY
Mailing Address - State:AK
Mailing Address - Zip Code:99840-0537
Mailing Address - Country:US
Mailing Address - Phone:907-983-2255
Mailing Address - Fax:907-983-2793
Practice Address - Street 1:350 14TH AVE
Practice Address - Street 2:
Practice Address - City:SKAGWAY
Practice Address - State:AK
Practice Address - Zip Code:99840-0537
Practice Address - Country:US
Practice Address - Phone:907-983-2255
Practice Address - Fax:907-983-2793
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7315101YP2500X
AK151871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1712999Medicaid