Provider Demographics
NPI:1760808869
Name:FRITEL, KIMBERLY K
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:FRITEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 18TH ST S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6789
Mailing Address - Country:US
Mailing Address - Phone:701-205-7771
Mailing Address - Fax:701-205-7771
Practice Address - Street 1:3210 18TH ST S STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6789
Practice Address - Country:US
Practice Address - Phone:701-205-7771
Practice Address - Fax:701-205-7771
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND853-11-15-15-312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional