Healthcare Provider Details

I. General information

NPI: 1104227644
Provider Name (Legal Business Name): KERSTE DECOTEAU LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGHWAY 2 W
DEVILS LAKE ND
58301-3532
US

IV. Provider business mailing address

2468 88TH ST
WILLOW CITY ND
58384-9009
US

V. Phone/Fax

Practice location:
  • Phone: 701-665-2200
  • Fax: 701-665-2300
Mailing address:
  • Phone: 701-278-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1132-6-15-21A
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number914-8-1-17A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: