| Inner Light Counseling Services | |
|
4675 40th Ave S Ste 115 Fargo ND 58104-4592 | |
| (701) 478-0906 | |
| (701) 478-0909 |
| Full Name | Inner Light Counseling Services |
|---|---|
| Speciality | Counselor |
| Location | 4675 40th Ave S Ste 115, Fargo, North Dakota |
| Authorized Official Name and Position | Mystal Axtman (OWNER) |
| Authorized Official Contact | 7014780906 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Light Counseling Services 4675 40th Ave S Ste 115 Fargo ND 58104-4592 Ph: (701) 478-0906 | Inner Light Counseling Services 4675 40th Ave S Ste 115 Fargo ND 58104-4592 Ph: (701) 478-0906 |
| NPI Number | 1740861954 |
|---|---|
| Provider Enumeration Date | 04/19/2021 |
| Last Update Date | 02/15/2023 |
| Certification Date | 02/15/2023 |
| Medicare PECOS PAC ID | 4082057500 |
|---|---|
| Medicare Enrollment ID | O20240212001632 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740861954 | NPI | - | NPPES |
| Provider Name | Mystal Rae Axtman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285775569 PECOS PAC ID: 9436592953 Enrollment ID: I20240213002796 |
| Provider Name | Lisa Ann Mastel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013934652 PECOS PAC ID: 2062856404 Enrollment ID: I20240214000618 |
| Provider Name | Megan Week |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386164358 PECOS PAC ID: 2365853561 Enrollment ID: I20240220001797 |
| Provider Name | Anne K Witteman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669880381 PECOS PAC ID: 0345687489 Enrollment ID: I20240325001589 |
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