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General NPI Number Information
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NPI Number | 1033971817
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Entity Type | Organization
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Legal Business Name | FIREFLY MENTAL HEALTH LLC
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 4891 MILLER TRUNK HWY STE 206
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City | HERMANTOWN
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State | MN
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Zip | 55811-1563
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Country | US
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Telephone | 218-306-8383
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Fax | 218-875-6315
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Provider Business Mailing Address
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Address Line | 4891 MILLER TRUNK HWY STE 206
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City | HERMANTOWN
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State | MN
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Zip | 55811-1563
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Country | US
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Telephone | 218-306-8383
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Fax | 218-875-6315
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Authorized Official
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Title or Position | OWNER
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Name | KARISSA HAUGEN
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Credential | APRN-PMHNP
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Telephone | 218-306-8383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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