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General NPI Number Information
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NPI Number | 1700972122
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Entity Type | Organization
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Legal Business Name | AGASSIZ ASSOCIATES, PLLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 2424 32ND AVE S STE 202
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City | GRAND FORKS
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State | ND
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Zip | 58201-6545
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Country | US
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Telephone | 701-746-6336
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Fax | 701-772-1030
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Provider Business Mailing Address
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Address Line | 2424 32ND AVE S STE 202
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City | GRAND FORKS
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State | ND
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Zip | 58201-6545
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Country | US
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Telephone | 701-746-6336
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Fax | 701-772-1030
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Authorized Official
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Title or Position | CO-OWNER
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Name | REBECCA M. GREEN
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Credential | PH.D.
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Telephone | 701-746-6336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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