Provider Demographics
NPI:1295858454
Name:AUDREY KAZMIERCZAK COUNSELING SERVICE
Entity Type:Organization
Organization Name:AUDREY KAZMIERCZAK COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMIERCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC LPCC
Authorized Official - Phone:701-471-1170
Mailing Address - Street 1:418 EAST ROSSER AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4046
Mailing Address - Country:US
Mailing Address - Phone:701-471-1170
Mailing Address - Fax:
Practice Address - Street 1:418 EAST ROSSER AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4046
Practice Address - Country:US
Practice Address - Phone:701-471-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDLAC1243101YA0400X
NDLPCC93719165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21792OtherBCBS
ND22619OtherBCBS