Provider Demographics
NPI:1457084717
Name:KHIBNIK, LENA (LAPC)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:KHIBNIK
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 18TH ST S STE 4
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6564
Mailing Address - Country:US
Mailing Address - Phone:701-248-9295
Mailing Address - Fax:
Practice Address - Street 1:3220 18TH ST S STE 4
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6564
Practice Address - Country:US
Practice Address - Phone:701-248-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1214-7-1-22A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional