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Organization

BLOOMING PRAIRIE ASSESSMENT & THERAPY CENTER P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SARA K KENNEY PSYD (LICENSED PSYCHOLOGIST)
(701) 662-8255
Entity
Organization

Contact information

Practice address
211 4TH ST NE, STE 4, DEVILS LAKE, ND 58301-2479
(701) 662-8255
(701) 662-1739
Mailing address
211 4TH ST NE, STE 4, DEVILS LAKE, ND 58301-2479
(701) 662-8255
(701) 662-1739

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
377
ND
103TC0700X
Clinical Psychologist
464
ND
1041C0700X
Clinical Social Worker
4370
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
14303
ND
01
600066
VALUE OPTIONS
ND
01
6978-001
BCBS OF ND
ND
Enumeration date
08/07/2007
Last updated
04/17/2013
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