Provider Demographics
NPI:1922524156
Name:ROMAN, CRIS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:CRIS
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 BIRCH ST S
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1533
Mailing Address - Country:US
Mailing Address - Phone:320-455-1560
Mailing Address - Fax:
Practice Address - Street 1:5985 RICE CREEK PKWY STE 201
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5037
Practice Address - Country:US
Practice Address - Phone:651-348-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3258106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist