MEDICARE: NICOLE LADOUCEUR LPCC

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	1028-9-15-19-472	ND
2	101YP2500X	Professional Counselor	1028-9-15-19-472	ND

General Provider Information

NPI Number	:	1942033329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LADOUCEUR LPCC

Provider Business Mailing Address
First Line	:	414 OAK ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4575 32ND AVE S STE 3
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-3305
Country	:	US
Telephone Number	:	701-740-4200
Fax Number	:

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

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	11/06/2024

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Directions to “ NICOLE LADOUCEUR LPCC” Practice Location

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