Individual provider Active NPI

Kim T Lahaise, PHD

  • Psychologist
  • West Fargo, ND
National Provider Identifier
1376560045
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
330 Issued in ND
Practice address
1401 13TH Ave E
West Fargo, ND 58078-3468
Phone
(701) 364-0060
Fax
(701) 364-0065
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychoanalysis Psychologist 103TP0814X 330 ND
Psychologist 103T00000X 330 ND Primary

Addresses

Primary practice location

1401 13TH Ave E
West Fargo, ND 58078-3468

Mailing address

700 1St Ave S
Fargo, ND 58103-1802
Phone (701) 234-4111

Other practice location 1

700 1st Ave S
Fargo, ND 58103-1802
Phone (701) 234-4111

Other practice location 2

1220 Main Ave Ste 100
Fargo, ND 58103-8233
Phone (701) 297-7588

Other identifiers 2

IdentifierTypeStateIssuer
689480100MedicaidMN
11096MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101228000508 ND Practitioner - Clinical Psychologist 9335337815 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Knowlton O'Neill and Associates PCGroup PAC ID 7214924679, 10 clinicians

Practice addresses (Care Compare)

1401 13TH Ave E
West Fargo, ND 58078-3402
Phone (701) 364-0060

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
330NDMDPsychoanalysis Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Knowlton, O'Neill & Associates, P.C. Psychologist CurrentSince Apr 1, 2025 Accepting new patients
Neuropsychology Associates, PA CurrentSince Oct 2, 2019 Accepting new patients
Carita R Shawchuck, PHD, PC Past Accepting new patients
Kennelly Speech Language Pathology LTD PastSince Oct 2, 2019 Accepting new patients

Locations

1220 Main Ave
Ste 100
Fargo, ND 58103
Phone (701) 297-7588

1401 13th Ave E
West Fargo, ND 58078
Phone (701) 364-0060

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1376560045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 1ST AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031802",
            "telephone_number": "701-234-4111",
            "fax_number": "701-234-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 13TH AVE E",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580783468",
            "telephone_number": "701-364-0060",
            "fax_number": "701-364-0065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 1st Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581031802",
            "country_code": "US",
            "telephone_number": "701-234-4111",
            "fax_number": "701-234-4024",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1220 Main Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581038233",
            "country_code": "US",
            "telephone_number": "701-297-7588",
            "fax_number": "701-364-2256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAHAISE",
        "first_name": "KIM",
        "middle_name": "T",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0814X",
            "taxonomy_group": "",
            "desc": "Psychologist, Psychoanalysis",
            "state": "ND",
            "license": "330",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ND",
            "license": "330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "689480100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11096",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Fargo, ND

Sources for this page

Verify at the official NPI Registry.