1740172550 NPI number — MR. THOMAS KENNETH DUBBELS M.S., LPC

Table of content: MR. THOMAS KENNETH DUBBELS M.S., LPC (NPI 1740172550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740172550 NPI number — MR. THOMAS KENNETH DUBBELS M.S., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUBBELS
Provider First Name:
THOMAS
Provider Middle Name:
KENNETH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740172550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1051 50TH AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58078-7213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-388-6194
Provider Business Mailing Address Fax Number:
701-450-0457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4357 13TH AVE S STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-7504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-306-8369
Provider Business Practice Location Address Fax Number:
701-450-0457
Provider Enumeration Date:
07/16/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  819-1-15-15 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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