Healthcare Provider Details

I. General information

NPI: 1467993774
Provider Name (Legal Business Name): KRISTIE HILLS LPCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 TOWN ROAD 136
BAUDETTE MN
56623-9220
US

IV. Provider business mailing address

832 TOWN ROAD 136
BAUDETTE MN
56623-9220
US

V. Phone/Fax

Practice location:
  • Phone: 218-390-8797
  • Fax:
Mailing address:
  • Phone: 218-390-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1579
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7279
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: