Provider Demographics
NPI:1417716705
Name:COLE, KRISTIN BEETY (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BEETY
Last Name:COLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:A
Other - Last Name:BEETY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:4999 OBSIDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-7401
Mailing Address - Country:US
Mailing Address - Phone:952-239-2322
Mailing Address - Fax:
Practice Address - Street 1:4999 OBSIDIAN WAY
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-7401
Practice Address - Country:US
Practice Address - Phone:952-239-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist