Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LPC-6456 | ID |
NPI | 1003140625 |
---|---|
Provider Name | Ms. Krista N Haller |
First Address | Sandpoint, ID 83864-1956 |
Second Address | Sandpoint, ID 83864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2009 |
Last Update Date | 06/05/2019 |