Provider Demographics
NPI:1073047395
Name:KURTTI, CARLYSS ANN (LPCC)
Entity Type:Individual
Prefix:MS
First Name:CARLYSS
Middle Name:ANN
Last Name:KURTTI
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:CARLYSS
Other - Middle Name:ANN
Other - Last Name:NEUFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, NCC
Mailing Address - Street 1:151 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4715
Practice Address - Country:US
Practice Address - Phone:701-235-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00992101Y00000X, 101YM0800X, 101YP2500X
ND619-11-1-08-223101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health