Healthcare Provider Details

I. General information

NPI: 1326320904
Provider Name (Legal Business Name): KRISTEN ENBLOM LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 HELENA AVE
HELENA MT
59601-3559
US

IV. Provider business mailing address

1124 HELENA AVE
HELENA MT
59601-3559
US

V. Phone/Fax

Practice location:
  • Phone: 406-465-9990
  • Fax:
Mailing address:
  • Phone: 406-465-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number32809
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number726-8-15-12-214
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: