Healthcare Provider Details

I. General information

NPI: 1437781515
Provider Name (Legal Business Name): AUTONOMY COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOLIDAY DR STE 170
MOORHEAD MN
56560-4400
US

IV. Provider business mailing address

800 HOLIDAY DR STE 170
MOORHEAD MN
56560-4400
US

V. Phone/Fax

Practice location:
  • Phone: 218-979-3828
  • Fax: 218-231-8914
Mailing address:
  • Phone: 218-979-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARSHA MARIE WERNER
Title or Position: OWNER
Credential: LMFT
Phone: 360-850-8588