Provider Demographics
NPI:1770795874
Name:HARBOUR, CRISTIE ANNE (MS)
Entity type:Individual
Prefix:MS
First Name:CRISTIE
Middle Name:ANNE
Last Name:HARBOUR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1116
Mailing Address - Country:US
Mailing Address - Phone:608-445-0720
Mailing Address - Fax:
Practice Address - Street 1:619 RIVER ST
Practice Address - Street 2:SUITE F
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9117
Practice Address - Country:US
Practice Address - Phone:608-424-9100
Practice Address - Fax:608-424-9099
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39767200Medicaid