Healthcare Provider Details

I. General information

NPI: 1447352679
Provider Name (Legal Business Name): KAREN EAST MSMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN EAST LMFT

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 3RD AVE N
FORT TOTTEN ND
58335-9998
US

IV. Provider business mailing address

504 3RD AVE S
NEW ROCKFORD ND
58356-1627
US

V. Phone/Fax

Practice location:
  • Phone: 701-766-4236
  • Fax:
Mailing address:
  • Phone: 715-416-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12423
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number714-124
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2011-037
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number594
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11665
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: