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General NPI Number Information
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NPI Number | 1649727280
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Entity Type | Organization
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Legal Business Name | MELISSA NYSTUEN AND JESSICA WATTERUD COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 17 MAIN ST S
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City | CROSBY
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State | ND
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Zip | 58730-6319
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Country | US
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Telephone | 701-240-5498
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 136 17 MAIN ST S
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City | CROSBY
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State | ND
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Zip | 58730-6319
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Country | US
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Telephone | 701-240-5498
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Fax |
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Authorized Official
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Title or Position | LPCC
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Name | JESSICA WATTERUD
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Credential |
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Telephone | 701-240-5498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 228
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License Number State | ND
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