Healthcare Provider Details

I. General information

NPI: 1750132965
Provider Name (Legal Business Name): LANDENBERGER COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 N 4TH ST
BISMARCK ND
58501-4055
US

IV. Provider business mailing address

412 N 23RD ST
BISMARCK ND
58501-4916
US

V. Phone/Fax

Practice location:
  • Phone: 701-391-1149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL CAROL LANDENBERGER
Title or Position: LPCC/COUNSELOR
Credential: LPCC
Phone: 701-391-1149