Healthcare Provider Details

I. General information

NPI: 1851784987
Provider Name (Legal Business Name): JEANNE MARIE HETTICH FARNSWORTH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNE MARIE HETTICH

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 LOVETT AVE STE 9
BISMARCK ND
58504-3604
US

IV. Provider business mailing address

1925 LOVETT AVE STE 9
BISMARCK ND
58504-3604
US

V. Phone/Fax

Practice location:
  • Phone: 701-204-9341
  • Fax:
Mailing address:
  • Phone: 701-204-9341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number825-3-1-15A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: