Provider Demographics
NPI:1821894189
Name:TOMFORD, KRISTA (LADC, CRC)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:TOMFORD
Suffix:
Gender:
Credentials:LADC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 24TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4342
Mailing Address - Country:US
Mailing Address - Phone:320-309-4020
Mailing Address - Fax:
Practice Address - Street 1:1501 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1710
Practice Address - Country:US
Practice Address - Phone:612-659-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306084101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)