1730686502 NPI number — KRYSTA HALLORAN LCMHC

Table of content: KATHLEEN A HARDING RN, ADVANCED PRACTIC (NPI 1154525632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730686502 NPI number — KRYSTA HALLORAN LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALLORAN
Provider First Name:
KRYSTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARLSON
Provider Other First Name:
KRYSTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730686502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 WALL ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03101-1518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-668-4111
Provider Business Mailing Address Fax Number:
603-628-7757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03101-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-668-4111
Provider Business Practice Location Address Fax Number:
603-628-7757
Provider Enumeration Date:
04/09/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 4839 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)