Healthcare Provider Details

I. General information

NPI: 1104125483
Provider Name (Legal Business Name): STEIN SPECIALIZED COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 S BROADWAY SUITE A
MINOT ND
58701-6567
US

IV. Provider business mailing address

1809 S BROADWAY SUITE A
MINOT ND
58701-6567
US

V. Phone/Fax

Practice location:
  • Phone: 701-833-2085
  • Fax: 701-837-1360
Mailing address:
  • Phone: 701-833-2085
  • Fax: 701-837-1360

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: SUSAN STEIN
Title or Position: OWNER
Credential: LICSW
Phone: 701-833-2085