Healthcare Provider Details

I. General information

NPI: 1639767791
Provider Name (Legal Business Name): GROSLIE COUNSELING SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 03/29/2024
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 24 AVE S STE 102
FARGO ND
58104-9038
US

IV. Provider business mailing address

4160 24 AVE S STE 102
FARGO ND
58104-9038
US

V. Phone/Fax

Practice location:
  • Phone: 701-941-0175
  • Fax: 701-941-3001
Mailing address:
  • Phone: 701-941-0175
  • Fax: 701-941-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWN GROSLIE
Title or Position: OWNER
Credential: LPCC
Phone: 701-941-0175