| Jdl Counseling Llc | |
|
1128 Westrac Dr S Fargo ND 58103-8729 | |
| (701) 490-6812 | |
| Not Available |
| Full Name | Jdl Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 1128 Westrac Dr S, Fargo, North Dakota |
| Authorized Official Name and Position | Julie Larson (OWNER) |
| Authorized Official Contact | 7014906812 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jdl Counseling Llc 1128 Westrac Dr S Ste A Fargo ND 58103-8729 Ph: (701) 490-6812 | Jdl Counseling Llc 1128 Westrac Dr S Fargo ND 58103-8729 Ph: (701) 490-6812 |
| NPI Number | 1861003089 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 11/17/2022 |
| Certification Date | 11/17/2022 |
| Medicare PECOS PAC ID | 5698192839 |
|---|---|
| Medicare Enrollment ID | O20200902000811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861003089 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Lisa K Rorvig |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821277328 PECOS PAC ID: 2062653256 Enrollment ID: I20130731000386 |
| Provider Name | Julie D Larson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932365806 PECOS PAC ID: 5193947232 Enrollment ID: I20190219000698 |
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