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General NPI Number Information
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NPI Number | 1760396576
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Entity Type | Organization
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Legal Business Name | SOUTHEAST BEHAVIORAL HEALTH CLINIC
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 2624 9TH AVE S
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City | FARGO
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State | ND
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Zip | 58103-2350
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Country | US
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Telephone | 701-298-4500
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Fax | 701-298-4400
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Provider Business Mailing Address
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Address Line | 2624 9TH AVE S
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City | FARGO
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State | ND
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Zip | 58103-2350
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Country | US
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Telephone | 701-298-4500
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Fax | 701-298-4400
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Authorized Official
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Title or Position | CLAIMS AND CLIENT ACCOUNTS MANAGER
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Name | LUCY OLSON
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Credential |
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Telephone | 701-328-8580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State | NULL
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