Healthcare Provider Details

I. General information

NPI: 1740908722
Provider Name (Legal Business Name): MAVEN COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3369 39TH ST S STE 3
FARGO ND
58104-7542
US

IV. Provider business mailing address

3369 39TH ST S STE 3
FARGO ND
58104-7542
US

V. Phone/Fax

Practice location:
  • Phone: 701-367-0057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DENISE LEEBY
Title or Position: OWNER
Credential:
Phone: 701-367-0057