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General NPI Number Information
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NPI Number | 1750653580
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Entity Type | Individual
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Provider Name | KRYSTLE ELIZABETH HAVILAND LPC, CSAC, ICS
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Gender | Female
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 159 S FAIR OAKS AVE
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City | MADISON
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State | WI
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Zip | 53704-5820
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Country | US
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Telephone | 608-620-5209
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Fax |
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Provider Business Mailing Address
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Address Line | 2413 MIDDLETON BEACH RD
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City | MIDDLETON
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State | WI
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Zip | 53562-2910
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Country | US
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Telephone | 715-781-1653
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16489-130
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License Number State | WI
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1238-266
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License Number State | WI
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