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NPI Code Detail

MEDICARE: CODY DOUGLAS SPEARS

MEDICARE: CODY DOUGLAS SPEARS
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
1101YM0800XMental Health Counselor1365-6-15-24ND
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1952176208
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODY DOUGLAS SPEARS
Provider Business Mailing Address
First Line : 2624 9TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-2350
Country : US
Telephone Number : 701-298-4500
Fax Number :
Provider Business Practice Location Address
First Line : 2624 9TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-2350
Country : US
Telephone Number : 701-298-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2023
Last Update Date : 05/27/2026

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Directions to “ CODY DOUGLAS SPEARS ” Practice Location

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