MEDICARE: CRISTI HABERMANN MA-LPC LAX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC 1142	SD
2	101YM0800X	Mental Health Counselor	LAC06091282	SD

General Provider Information

NPI Number	:	1023129327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTI HABERMANN MA-LPC LAX

Provider Business Mailing Address
First Line	:	1924 ELK RD
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-3316
Country	:	US
Telephone Number	:	605-490-4229
Fax Number	:	605-341-2072

Provider Business Practice Location Address
First Line	:	2650 JACKSON BLVD STE 19-A
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3474
Country	:	US
Telephone Number	:	605-490-4229
Fax Number	:	605-341-2072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/30/2016

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