Provider Demographics
NPI:1659065811
Name:KUYLEN, SARAH BETH (LAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:KUYLEN
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 1:66 W MUSEUM DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3864
Mailing Address - Country:US
Mailing Address - Phone:701-456-7790
Mailing Address - Fax:
Practice Address - Street 1:440 MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:NEW ENGLAND
Practice Address - State:ND
Practice Address - Zip Code:58647-7310
Practice Address - Country:US
Practice Address - Phone:701-579-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1661101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)