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General NPI Number Information
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NPI Number | 1003140625
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Entity Type | Individual
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Provider Name | KRISTA N HALLER M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 212 N 1ST AVE STE 203
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City | SANDPOINT
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State | ID
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Zip | 83864
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Country | US
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Telephone | 208-946-5242
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Fax |
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Provider Business Mailing Address
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Address Line | 702 RUTH AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1956
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Country | US
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Telephone | 530-262-3497
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-6456
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License Number State | ID
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