Basic Information
| Provider Information | |||||||||
| NPI: | 1740432855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIN | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 SILVER LAKE ROAD NW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513791764 | ||||||||
| FaxNumber: | 6513791738 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SILVER LAKE ROAD NW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516289566 | ||||||||
| FaxNumber: | 6516280411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 095044 | IA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 178005000 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | CC00249 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.