Healthcare Provider Details

I. General information

NPI: 1134966989
Provider Name (Legal Business Name): FAMILY BEHAVIORAL HEALTH COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 28TH AVE S STE 101B
MOORHEAD MN
56560-4420
US

IV. Provider business mailing address

302 US-75
MOORHEAD MN
56560
US

V. Phone/Fax

Practice location:
  • Phone: 623-216-5759
  • Fax:
Mailing address:
  • Phone: 623-216-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAUL BANGURA
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-216-5759