Provider Demographics
NPI:1922693308
Name:PURPOSE COUNSELING PC
Entity Type:Organization
Organization Name:PURPOSE COUNSELING PC
Other - Org Name:CHAD J BROWN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-941-0175
Mailing Address - Street 1:4160 24TH AVE S
Mailing Address - Street 2:STE 102
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-9038
Mailing Address - Country:US
Mailing Address - Phone:701-941-0175
Mailing Address - Fax:701-941-3001
Practice Address - Street 1:4160 24TH AVE S
Practice Address - Street 2:STE 102
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-9038
Practice Address - Country:US
Practice Address - Phone:701-941-0175
Practice Address - Fax:701-941-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1482834Medicaid