Provider Demographics
NPI:1295541381
Name:BERTELSEN, KRIS (PHD, MA)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:BERTELSEN
Suffix:
Gender:M
Credentials:PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2517
Mailing Address - Country:US
Mailing Address - Phone:507-696-2249
Mailing Address - Fax:
Practice Address - Street 1:10310 WEST MARKHAM
Practice Address - Street 2:SUITE 222, UNIT 11
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1579
Practice Address - Country:US
Practice Address - Phone:507-218-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2412001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health