Healthcare Provider Details

I. General information

NPI: 1306410550
Provider Name (Legal Business Name): SARA KELNER LPCC LMAC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 4TH ST NE STE 7
DEVILS LAKE ND
58301-2479
US

IV. Provider business mailing address

PO BOX 151
CANDO ND
58324-0151
US

V. Phone/Fax

Practice location:
  • Phone: 701-381-9911
  • Fax:
Mailing address:
  • Phone: 701-440-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARA C KELNER
Title or Position: OWNER
Credential: LPCC LMAC
Phone: 701-381-9911