Provider Demographics
NPI:1679015689
Name:KNUDSON BAUER COUNSELING, PLLP
Entity Type:Organization
Organization Name:KNUDSON BAUER COUNSELING, PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:KNUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:701-885-1080
Mailing Address - Street 1:1407 24TH AVE S
Mailing Address - Street 2:SUITE #203
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6761
Mailing Address - Country:US
Mailing Address - Phone:701-765-3228
Mailing Address - Fax:134-741-2887
Practice Address - Street 1:1407 24TH AVE S
Practice Address - Street 2:SUITE #203
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6761
Practice Address - Country:US
Practice Address - Phone:701-765-3228
Practice Address - Fax:134-741-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND767-12-15-13-274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty