Provider Demographics
NPI:1114651403
Name:HAUGROSE MICKELSON, NANCY LYNN (MRC,LPCC,NCC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:HAUGROSE MICKELSON
Suffix:
Gender:F
Credentials:MRC,LPCC,NCC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LYNN
Other - Last Name:AHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 20TH AVE SW STE 4
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6572
Mailing Address - Country:US
Mailing Address - Phone:701-721-0711
Mailing Address - Fax:
Practice Address - Street 1:104 20TH AVE SW STE 4
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6572
Practice Address - Country:US
Practice Address - Phone:701-721-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1010-6-1-19-481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health