Individual
MARY LOU KLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 25TH ST S, FARGO, ND 58103-2311
(701) 451-4900
(701) 451-5057
Mailing address
4068 40TH AVE S, MOORHEAD, MN 56560-7504
(701) 451-4900
(701) 451-5057
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
11721
MN
101Y00000X
Counselor
Primary
2841
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067H4BR
BCBSMN
MN
05
—
158498700
—
MN
05
—
19162
—
ND
01
—
26563
BCBSND
ND
01
—
58103-A009
TRIWEST
ND
01
—
62-67227
MEDICA UBH
ND
01
—
HP59873
HEALTH PARTNERS
ND
Enumeration date
02/21/2007
Last updated
07/08/2007
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