Provider Demographics
NPI:1235930074
Name:RAWLEIGH, KRISTI (MA, LPCC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:RAWLEIGH
Suffix:
Gender:
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30188 FOXTAIL LN
Mailing Address - Street 2:
Mailing Address - City:STACY
Mailing Address - State:MN
Mailing Address - Zip Code:55079-9650
Mailing Address - Country:US
Mailing Address - Phone:612-599-1073
Mailing Address - Fax:
Practice Address - Street 1:740 E 24TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3862
Practice Address - Country:US
Practice Address - Phone:612-238-6238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FMCC04866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health