Provider Demographics
NPI:1104101369
Name:LEE, KRISTA ANN DUFRESNE (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN DUFRESNE
Last Name:LEE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ANN
Other - Last Name:DUFRESNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:570 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2756
Mailing Address - Country:US
Mailing Address - Phone:507-301-3412
Mailing Address - Fax:
Practice Address - Street 1:17305 CEDAR AVE S STE 230
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-3903
Practice Address - Country:US
Practice Address - Phone:507-301-3412
Practice Address - Fax:507-301-3308
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist