Provider Demographics
NPI:1821772229
Name:URIELL-UNRUH, CARRIE ANN (LADC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:URIELL-UNRUH
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-3626
Mailing Address - Country:US
Mailing Address - Phone:701-212-3975
Mailing Address - Fax:
Practice Address - Street 1:1401 8TH ST S STE 3
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3658
Practice Address - Country:US
Practice Address - Phone:218-284-1800
Practice Address - Fax:218-600-5484
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305885101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)