Healthcare Provider Details

I. General information

NPI: 1679110969
Provider Name (Legal Business Name): MOORHEAD COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 30TH AVE S STE C
MOORHEAD MN
56560-5146
US

IV. Provider business mailing address

1500 30TH AVE S STE C
MOORHEAD MN
56560-5146
US

V. Phone/Fax

Practice location:
  • Phone: 218-451-3614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NATASHA BRASETH
Title or Position: OWNER
Credential:
Phone: 218-451-3614