Healthcare Provider Details

I. General information

NPI: 1548339971
Provider Name (Legal Business Name): VANESSA R HANDTE LAC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 9TH AVE SW SOUTHEAST HUMAN SERVICE CENTER
FARGO ND
58103-2350
US

IV. Provider business mailing address

1513 40TH AVE S
FARGO ND
58104
US

V. Phone/Fax

Practice location:
  • Phone: 701-298-4445
  • Fax:
Mailing address:
  • Phone: 701-364-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1383
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number578-2-15-07
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier25640
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS
# 2
Identifier412781043738
Identifier TypeOTHER
Identifier State
Identifier IssuerPREFERRED ONE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: