Healthcare Provider Details

I. General information

NPI: 1801632807
Provider Name (Legal Business Name): ALYSSA EICHHORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4143 26TH AVE S STE 100
FARGO ND
58104-7919
US

IV. Provider business mailing address

3807 30TH AVE S APT 312
FARGO ND
58104-7751
US

V. Phone/Fax

Practice location:
  • Phone: 701-639-2937
  • Fax:
Mailing address:
  • Phone: 701-430-3766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1370-7-1-24
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: