MEDICARE: MR. THOMAS KENNETH DUBBELS M.S., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	819-1-15-15	ND

General Provider Information

NPI Number	:	1740172550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS KENNETH DUBBELS M.S., LPC

Provider Business Mailing Address
First Line	:	1051 50TH AVE W
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-7213
Country	:	US
Telephone Number	:	701-388-6194
Fax Number	:	701-450-0457

Provider Business Practice Location Address
First Line	:	4357 13TH AVE S STE 104
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-7504
Country	:	US
Telephone Number	:	701-306-8369
Fax Number	:	701-450-0457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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