Healthcare Provider Details

I. General information

NPI: 1770100877
Provider Name (Legal Business Name): HALABRIN MARTY AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 17TH ST SE
FOREST LAKE MN
55025-2022
US

IV. Provider business mailing address

1032 17TH ST SE
FOREST LAKE MN
55025-2022
US

V. Phone/Fax

Practice location:
  • Phone: 763-421-1042
  • Fax:
Mailing address:
  • Phone: 763-421-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA J HALABRIN
Title or Position: PRESIDENT
Credential: PSY.D. , LP
Phone: 763-421-1042