Healthcare Provider Details

I. General information

NPI: 1225126030
Provider Name (Legal Business Name): PAULA J CONDOL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA J JOHS LPCC

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8041 WHITE OAK LOOP
BISMARCK ND
58501-9330
US

IV. Provider business mailing address

8041 WHITE OAK LOOP
BISMARCK ND
58501-9330
US

V. Phone/Fax

Practice location:
  • Phone: 701-202-7073
  • Fax:
Mailing address:
  • Phone: 701-202-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number402-4-15-98-123
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number402-4-15-98-123
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: