Provider Demographics
NPI:1063948388
Name:FUGLE, KATIE (LPCC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:FUGLE
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 1:3101 S FRONTAGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2545
Mailing Address - Country:US
Mailing Address - Phone:844-287-8428
Mailing Address - Fax:
Practice Address - Street 1:3101 S FRONTAGE RD STE 100
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2545
Practice Address - Country:US
Practice Address - Phone:844-287-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4345101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional