Healthcare Provider Details

I. General information

NPI: 1851771539
Provider Name (Legal Business Name): SARA KELNER LPCC LMAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
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 Number1765
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number888-10-15-16-377
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: