Provider Demographics
NPI:1609227180
Name:RAY OF HOPE COUNSELONG SERVICES
Entity Type:Organization
Organization Name:RAY OF HOPE COUNSELONG SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOE
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LADC
Authorized Official - Phone:701-793-7692
Mailing Address - Street 1:3140 BLUE STEM DR
Mailing Address - Street 2:#405
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8009
Mailing Address - Country:US
Mailing Address - Phone:701-793-7692
Mailing Address - Fax:
Practice Address - Street 1:3140 BLUE STEM DR
Practice Address - Street 2:#405
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8009
Practice Address - Country:US
Practice Address - Phone:701-793-7692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1651101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty