Provider Demographics
NPI:1962709790
Name:HAUGEN, KRYSTLE (LMFT)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:
Other - Last Name:BARRUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:205 W 2ND ST STE 150D
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1920
Mailing Address - Country:US
Mailing Address - Phone:218-480-0145
Mailing Address - Fax:
Practice Address - Street 1:205 W 2ND ST STE 150D
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1920
Practice Address - Country:US
Practice Address - Phone:218-480-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1962709790Medicaid