Provider Demographics
NPI:1033971817
Name:FIREFLY MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:FIREFLY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-PMHNP
Authorized Official - Phone:218-306-8383
Mailing Address - Street 1:4891 MILLER TRUNK HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1563
Mailing Address - Country:US
Mailing Address - Phone:218-306-8383
Mailing Address - Fax:218-875-6315
Practice Address - Street 1:4891 MILLER TRUNK HWY STE 206
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1563
Practice Address - Country:US
Practice Address - Phone:218-306-8383
Practice Address - Fax:218-875-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty