1568656916 NPI number — DRAKE COUNSELING SERVICES

Table of content: (NPI 1568656916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568656916 NPI number — DRAKE COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRAKE COUNSELING SERVICES
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:
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:
1568656916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 23RD ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-293-5929
Provider Business Mailing Address Fax Number:
701-293-0736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 2ND AVE NE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-952-1250
Provider Business Practice Location Address Fax Number:
701-952-1252
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAREBERG
Authorized Official First Name:
TERI
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
701-293-5429

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , 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)

  • Identifier: 3002 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com