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NPI Code Detail

MEDICARE: SOUTHEAST BEHAVIORAL HEALTH CLINIC

MEDICARE: SOUTHEAST BEHAVIORAL HEALTH CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center
2261Q00000XClinic/Center
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
4261QM0855XAdolescent and Children Mental Health Clinic/Center
5261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center1015ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
290981SOOTHERMNBCBS OF MN
3100001OTHERNDBCBS OF ND

General Provider Information

NPI Number : 1932146941
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST BEHAVIORAL HEALTH CLINIC
Provider Business Mailing Address
First Line : 2624 9TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-2350
Country : US
Telephone Number : 701-298-4500
Fax Number : 701-298-4400
Provider Business Practice Location Address
First Line : 2624 9TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-2350
Country : US
Telephone Number : 701-298-4500
Fax Number : 701-298-4400
Authorized Official
Title or Position : DIRECTOR
Name : JEFF J STENSETH
Credential :
Telephone Number : 701-298-4500
Provider Enumeration Date : 05/31/2006
Last Update Date : 03/31/2026

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2624 9TH AVE S
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1477232742 — ARTHUR VERNIK
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1093434557 — DAISY VICTORIA MURILLO
Practice Location Address:
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58103-2350
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1245284850 — SOUTHEAST HUMAN SERVICE CENTER
Practice Location Address:
2624 9TH AVE S
FARGO, ND
58103-2350
Practice Phone: 701-298-4500
Practice Fax:
1922055243 — SOUTHEAST HUMAN SERVICE CENTER
Practice Location Address:
2624 9TH AVE S
FARGO, ND
58103-2350
Practice Phone: 701-298-4500
Practice Fax:
1346280435 — COLEEN R MAY MSW
Practice Location Address:
2624 9TH AVE S
FARGO, ND
58103-2350
Practice Phone: 701-298-4500
Practice Fax: 701-298-4400

Directions to “SOUTHEAST BEHAVIORAL HEALTH CLINIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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