Provider Demographics
NPI:1881807402
Name:FLUKE, KATHERINE (LIC, MFT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FLUKE
Suffix:
Gender:F
Credentials:LIC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1404 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2154
Practice Address - Country:US
Practice Address - Phone:218-283-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN930106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1027414OtherPREFERRED ONE
MN47B70FLOtherBCBS OF MINNESOTA
MN6231631OtherUNITED BEHAVIORAL SYSTEMS