Healthcare Provider Details

I. General information

NPI: 1083390900
Provider Name (Legal Business Name): JEREMY LEON SCHMALTZ LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SOUTH 4TH STREET SUITE 401
GRAND FORKS ND
58201
US

IV. Provider business mailing address

151 S 4TH ST STE 401
GRAND FORKS ND
58201-4715
US

V. Phone/Fax

Practice location:
  • Phone: 701-795-3084
  • Fax: 701-795-3050
Mailing address:
  • Phone: 701-795-3084
  • Fax: 701-795-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1304-6-15-23-653
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: