Healthcare Provider Details

I. General information

NPI: 1770795874
Provider Name (Legal Business Name): CRISTIE ANNE HARBOUR MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 RIVER ST SUITE F
BELLEVILLE WI
53508-9117
US

IV. Provider business mailing address

225 11TH AVE
MONROE WI
53566-1116
US

V. Phone/Fax

Practice location:
  • Phone: 608-424-9100
  • Fax: 608-424-9099
Mailing address:
  • Phone: 608-445-0720
  • Fax:

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: