Active NPI
Kim T Lahaise, PHD
- Psychologist
- West Fargo, ND
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 330
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 689480100 | Medicaid | MN | |
| 11096 | Medicaid | ND |
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
Enrollment records 1
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 330 | ND | MD | Psychoanalysis Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Knowlton, O'Neill & Associates, P.C. | Psychologist | Current | Accepting new patients |
| Neuropsychology Associates, PA | Current | Accepting new patients | |
| Carita R Shawchuck, PHD, PC | Past | Accepting new patients | |
| Kennelly Speech Language Pathology LTD | Past | 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.
-
- Psychologist
- West Fargo, ND
- NPI 1538198759
-
- Specialist
- Fargo, ND
- NPI 1669420923
-
- Clinical Child & Adolescent Psychologist
- Fargo, ND
- NPI 1013269257
-
- Speech-Language Pathologist
- Fargo, ND
- NPI 1154370187
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.