=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134300775
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER FRACH MS, LADC, LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2007
-----------------------------------------------------
Last Update Date | 04/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 BEMIDJI AVE N STE 16
-----------------------------------------------------
City | BEMIDJI
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56601-3884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-888-7980
-----------------------------------------------------
Fax | 218-888-7981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 PAUL BUNYAN DR NW # 150
-----------------------------------------------------
City | BEMIDJI
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56601-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-888-7980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 301828
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CC01458
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------