Provider Demographics
NPI:1558388249
Name:SAKELLARIOU, KAREN H (LAC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:H
Last Name:SAKELLARIOU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PULVER HALL
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4878
Mailing Address - Country:US
Mailing Address - Phone:701-227-1581
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:200 PULVER HALL
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4878
Practice Address - Country:US
Practice Address - Phone:701-227-1581
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1201101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54523Medicaid
ND09111OtherBCBS PIN