Provider Demographics
NPI:1922407717
Name:HALSETH, CHRISTAL (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:
Last Name:HALSETH
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-3239
Mailing Address - Country:US
Mailing Address - Phone:701-852-0836
Mailing Address - Fax:701-852-0623
Practice Address - Street 1:20 1ST ST SW
Practice Address - Street 2:SUITE 202
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3851
Practice Address - Country:US
Practice Address - Phone:701-852-0836
Practice Address - Fax:701-852-0623
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND43091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1461308Medicaid