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General NPI Number Information
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NPI Number | 1992503924
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Entity Type | Organization
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Legal Business Name | CENTER FOR BEHAVIORAL CHANGE
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 1450 25TH ST S
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City | FARGO
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State | ND
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Zip | 58103-8105
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Country | US
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Telephone | 701-356-1047
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Fax | 701-356-1052
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Provider Business Mailing Address
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Address Line | 1450 25TH ST S
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City | FARGO
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State | ND
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Zip | 58103-8105
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Country | US
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Telephone | 701-356-1047
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Fax | 701-356-1052
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Authorized Official
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Title or Position | OWNER
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Name | DR. RENAE M REINARDY SPIRY
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Credential | PSYD
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Telephone | 701-356-1047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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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