| 30:17 Counseling | |
|
1751 Main Ave E West Fargo ND 58078-2203 | |
| (701) 541-0313 | |
| Not Available |
| Full Name | 30:17 Counseling |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1751 Main Ave E, West Fargo, North Dakota |
| Authorized Official Name and Position | John Gabriel Perez (PROFESSIONAL CLINICAL COUNSELOR) |
| Authorized Official Contact | 7015410313 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 30:17 Counseling 1751 Main Ave E West Fargo ND 58078-2203 Ph: (701) 541-0313 | 30:17 Counseling 1751 Main Ave E West Fargo ND 58078-2203 Ph: (701) 541-0313 |
| NPI Number | 1225414956 |
|---|---|
| Provider Enumeration Date | 08/04/2015 |
| Last Update Date | 08/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225414956 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 666-9-1-10-243 (North Dakota) | Primary |
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