Healthcare Provider Details

I. General information

NPI: 1942862149
Provider Name (Legal Business Name): JAIME NICOLE RINGSTAD ED.D., LPC, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME NICOLE RINGSTAD ED.D., LPC, MAC

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 COWLES ST
FAIRBANKS AK
99701-5918
US

IV. Provider business mailing address

2111 COWLES ST
FAIRBANKS AK
99701-5918
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-2644
  • Fax:
Mailing address:
  • Phone: 907-458-2634
  • Fax: 907-459-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number162728
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: