Healthcare Provider Details

I. General information

NPI: 1548625528
Provider Name (Legal Business Name): CRYSTAL DUNHAM LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 NODAK DR S
FARGO ND
58103-2333
US

IV. Provider business mailing address

1021 26TH AVE W
WEST FARGO ND
58078-8427
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-6224
  • Fax: 701-232-4687
Mailing address:
  • Phone: 701-232-6224
  • Fax: 701-232-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number719-7-1-12-233
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: