Provider Demographics
NPI:1336702687
Name:ALTENDORF COUNSELING
Entity Type:Organization
Organization Name:ALTENDORF COUNSELING
Other - Org Name:ALTENDORF COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALTENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCC
Authorized Official - Phone:701-412-7345
Mailing Address - Street 1:1351 PAGE DR S STE 100
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3536
Mailing Address - Country:US
Mailing Address - Phone:701-412-7345
Mailing Address - Fax:
Practice Address - Street 1:1351 PAGE DR S STE 100
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3536
Practice Address - Country:US
Practice Address - Phone:701-412-7345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)