Provider Demographics
NPI:1861080434
Name:HASELTINE, KRYSTAL LYNN
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LYNN
Last Name:HASELTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6420
Mailing Address - Country:US
Mailing Address - Phone:931-538-8525
Mailing Address - Fax:
Practice Address - Street 1:44 VANTAGE WAY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1513
Practice Address - Country:US
Practice Address - Phone:931-247-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor