Provider Demographics
NPI:1679689954
Name:EXNER, NANCY ANN (LPCC, LAC, LSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:EXNER
Suffix:
Gender:F
Credentials:LPCC, LAC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8980 38TH ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-9709
Mailing Address - Country:US
Mailing Address - Phone:701-252-8292
Mailing Address - Fax:
Practice Address - Street 1:8980 38TH ST SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-9709
Practice Address - Country:US
Practice Address - Phone:701-252-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1028101YA0400X
ND89719187101YP2500X
ND380104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND009191OtherBCBS PROVIDER NUMBER LAC
ND018044OtherBCBS PROVIDER NUMBER LPCC