Provider Demographics
NPI:1861642134
Name:DUELM, KRISTI (LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:DUELM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:HALVERSON
Other - Last Name:DUELM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:2 GRAY WOLFE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1374
Mailing Address - Country:US
Mailing Address - Phone:618-288-5082
Mailing Address - Fax:
Practice Address - Street 1:2 GRAY WOLFE CT
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1374
Practice Address - Country:US
Practice Address - Phone:618-288-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional