Healthcare Provider Details

I. General information

NPI: 1255599098
Provider Name (Legal Business Name): NICHOLE L VENABLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 S WASHINGTON ST
GRAND FORKS ND
58201-6370
US

IV. Provider business mailing address

1201 25TH ST S
FARGO ND
58103-2311
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-4584
  • Fax: 651-925-0057
Mailing address:
  • Phone: 701-451-4900
  • Fax: 651-925-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4001
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4001
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: