Provider Demographics
NPI:1699027466
Name:KANG, KARA MAE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:MAE
Last Name:KANG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 E COPPER POINT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9276
Mailing Address - Country:US
Mailing Address - Phone:208-338-4699
Mailing Address - Fax:208-467-4722
Practice Address - Street 1:2971 E COPPER POINT DR STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9276
Practice Address - Country:US
Practice Address - Phone:208-376-5683
Practice Address - Fax:208-376-5690
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health