1295367449 NPI number — WINDS OF CHANGE COUNSELING SERVICES LLC

Table of content: (NPI 1295367449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295367449 NPI number — WINDS OF CHANGE COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDS OF CHANGE COUNSELING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1295367449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DICKINSON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58602-0810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-483-0230
Provider Business Mailing Address Fax Number:
701-483-0231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 7TH ST. W, DOOR A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKINSON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-483-0230
Provider Business Practice Location Address Fax Number:
701-483-0231
Provider Enumeration Date:
02/05/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CLINICAL PSYCHOLOGICAL
Authorized Official Telephone Number:
701-483-0230

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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