Healthcare Provider Details

I. General information

NPI: 1750597639
Provider Name (Legal Business Name): ONLY HUMAN COUNSELING SERVICES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 BROADWAY N STE 517
FARGO ND
58102-4946
US

IV. Provider business mailing address

118 BROADWAY N STE 517
FARGO ND
58102-4946
US

V. Phone/Fax

Practice location:
  • Phone: 701-476-0497
  • Fax: 701-298-7811
Mailing address:
  • Phone: 701-476-0497
  • Fax: 701-298-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1024
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1058
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number856
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number814
License Number StateND

VII. Legacy identifiers

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

# 1
Identifier000014
Identifier TypeOTHER
Identifier StateND
Identifier IssuerISAPS
# 2
Identifier27627
Identifier TypeOTHER
Identifier StateND
Identifier IssuerDUCKWITZ BCBS LICSW
# 3
Identifier27627
Identifier TypeOTHER
Identifier StateND
Identifier IssuerDUCKWITZ BCBS LAC PROVIDE
# 4
Identifier1176
Identifier TypeOTHER
Identifier StateND
Identifier IssuerLICENSE ADDICTION FACILIT

VIII. Authorized Official

Name: MS. LINDA F DUCKWITZ
Title or Position: CO-OWNER
Credential: LICSW, LAC
Phone: 701-476-0497