Provider Demographics
NPI:1477758845
Name:KLUG, MARNA J (LPCC)
Entity type:Individual
Prefix:
First Name:MARNA
Middle Name:J
Last Name:KLUG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5372
Mailing Address - Country:US
Mailing Address - Phone:218-773-8627
Mailing Address - Fax:
Practice Address - Street 1:1615 17TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5372
Practice Address - Country:US
Practice Address - Phone:701-795-8550
Practice Address - Fax:701-795-8550
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND462-6-15-01-154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND25033OtherNDBCBS PROVIDER NUMBER