Provider Demographics
NPI:1912359886
Name:L.I.S.T.E.N. INC
Entity Type:Organization
Organization Name:L.I.S.T.E.N. INC
Other - Org Name:LISTEN
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:701-746-7840
Mailing Address - Street 1:1407 24TH AVE S
Mailing Address - Street 2:100
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6761
Mailing Address - Country:US
Mailing Address - Phone:701-746-7840
Mailing Address - Fax:701-795-1900
Practice Address - Street 1:1407 24TH AVE S
Practice Address - Street 2:100
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6761
Practice Address - Country:US
Practice Address - Phone:701-746-7840
Practice Address - Fax:701-795-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND35366Medicaid
ND1456350Medicaid