Provider Demographics
NPI:1154019073
Name:HALDEMAN, KRISTEN (MFT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HALDEMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 INDIANA AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4287
Mailing Address - Country:US
Mailing Address - Phone:951-782-0040
Mailing Address - Fax:951-782-2010
Practice Address - Street 1:6800 INDIANA AVE STE 260
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4287
Practice Address - Country:US
Practice Address - Phone:951-782-0040
Practice Address - Fax:951-782-2010
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138832101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health