Healthcare Provider Details

I. General information

NPI: 1124799317
Provider Name (Legal Business Name): KAYLA ELAINE DURAND-GOHEEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYLA ELAINE DURAND LMSW

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST S STE 201
MINOT ND
58701-3872
US

IV. Provider business mailing address

4225 27TH ST SE
MINOT ND
58701-3064
US

V. Phone/Fax

Practice location:
  • Phone: 701-355-6800
  • Fax:
Mailing address:
  • Phone: 701-240-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5316
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5316
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: