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General NPI Number Information
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NPI Number | 1831981760
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Entity Type | Organization
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Legal Business Name | GREEN PRAIRIE COUNSELING PLLC
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 22 6TH ST N SUITE 3
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City | MOORHEAD
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State | MN
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Zip | 56560
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Country | US
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Telephone | 218-422-6032
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Fax |
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Provider Business Mailing Address
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Address Line | 2057 12TH ST W
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City | WEST FARGO
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State | ND
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Zip | 58078-4845
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Country | US
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Telephone | 701-205-2469
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHERIDAN ELIZABETH AVERSON
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Credential | LPCC
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Telephone | 701-205-2469
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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 |
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License Number State |
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