Provider Demographics
NPI:1750653580
Name:HAVILAND, KRYSTLE ELIZABETH (LPC, CSAC, ICS)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:ELIZABETH
Last Name:HAVILAND
Suffix:
Gender:F
Credentials:LPC, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 MIDDLETON BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2910
Mailing Address - Country:US
Mailing Address - Phone:715-781-1653
Mailing Address - Fax:
Practice Address - Street 1:159 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5820
Practice Address - Country:US
Practice Address - Phone:608-620-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16489-130101YA0400X
101YM0800X, 261QM0801X
WI1238-266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)