Provider Demographics
NPI:1124799317
Name:DURAND-GOHEEN, KAYLA ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELAINE
Last Name:DURAND-GOHEEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:ELAINE
Other - Last Name:DURAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4225 27TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3064
Mailing Address - Country:US
Mailing Address - Phone:701-240-9559
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN ST S STE 201
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3872
Practice Address - Country:US
Practice Address - Phone:701-355-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND53161041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty