Healthcare Provider Details

I. General information

NPI: 1053678375
Provider Name (Legal Business Name): KRISTA A ALBERT OQMHP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 HATCH DR SUITE #210
CARIBOU ME
04736-2161
US

IV. Provider business mailing address

43 HATCH DR SUITE #210
CARIBOU ME
04736-2161
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-6431
  • Fax: 207-492-3181
Mailing address:
  • Phone: 207-498-6431
  • Fax: 207-492-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: