Provider Demographics
NPI:1023129327
Name:HABERMANN, CRISTI (MA-LPC LAX)
Entity type:Individual
Prefix:
First Name:CRISTI
Middle Name:
Last Name:HABERMANN
Suffix:
Gender:F
Credentials:MA-LPC LAX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ELK RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-3316
Mailing Address - Country:US
Mailing Address - Phone:605-490-4229
Mailing Address - Fax:605-341-2072
Practice Address - Street 1:2650 JACKSON BLVD STE 19-A
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3474
Practice Address - Country:US
Practice Address - Phone:605-490-4229
Practice Address - Fax:605-341-2072
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC 1142101YM0800X
SDLAC06091282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health