Provider Demographics
NPI:1407408669
Name:JUNTUNEN, RACHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:JUNTUNEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ENGLAND
Mailing Address - State:ND
Mailing Address - Zip Code:58647-7310
Mailing Address - Country:US
Mailing Address - Phone:701-579-5100
Mailing Address - Fax:701-579-5101
Practice Address - Street 1:66 W MUSEUM DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3864
Practice Address - Country:US
Practice Address - Phone:701-456-7790
Practice Address - Fax:701-456-7687
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1522101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)