Provider Demographics
NPI:1770100877
Name:HALABRIN MARTY AND ASSOCIATES
Entity type:Organization
Organization Name:HALABRIN MARTY AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALABRIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD , LP
Authorized Official - Phone:763-421-1042
Mailing Address - Street 1:1032 17TH ST SE
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2022
Mailing Address - Country:US
Mailing Address - Phone:763-421-1042
Mailing Address - Fax:
Practice Address - Street 1:12760 ABERDEEN ST NE STE 2122760
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5845
Practice Address - Country:US
Practice Address - Phone:763-421-1042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health