Provider Demographics
NPI:1336397835
Name:JANIS, KATHLEEN OLIVIA (MA, LPCC, EMDR)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:OLIVIA
Last Name:JANIS
Suffix:
Gender:F
Credentials:MA, LPCC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 320TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUBUN
Mailing Address - State:MN
Mailing Address - Zip Code:56589-9009
Mailing Address - Country:US
Mailing Address - Phone:218-209-2434
Mailing Address - Fax:
Practice Address - Street 1:2647 320TH ST
Practice Address - Street 2:
Practice Address - City:WAUBUN
Practice Address - State:MN
Practice Address - Zip Code:56589-9009
Practice Address - Country:US
Practice Address - Phone:218-209-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health