Provider Demographics
NPI:1528081528
Name:WOODBURY FLADLAND, KARA BLISS (LPCC)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:BLISS
Last Name:WOODBURY FLADLAND
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:BLISS
Other - Last Name:KIPHUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:1720 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:701-461-5600
Mailing Address - Fax:701-461-5649
Practice Address - Street 1:1720 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-461-5600
Practice Address - Fax:701-461-5649
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4184199133101YP2500X
ND418-4-1-99-133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN924676200Medicaid