Provider Demographics
NPI:1447352679
Name:EAST, KAREN (MSMFT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:EAST
Suffix:
Gender:F
Credentials:MSMFT
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:EAST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:504 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1627
Mailing Address - Country:US
Mailing Address - Phone:715-416-0088
Mailing Address - Fax:
Practice Address - Street 1:816 3RD AVE N
Practice Address - Street 2:
Practice Address - City:FORT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335-9998
Practice Address - Country:US
Practice Address - Phone:701-766-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124231041C0700X
WI714-124106H00000X
ND2011-037106H00000X
WI594101YA0400X
WI11665101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2011-037OtherNORTH DAKOTA MARRIAGE & FAMILY LICENSURE BOARD
MN12423OtherLICSW
WI714-124OtherMSMFT LICENSURE