Provider Demographics
NPI:1932659125
Name:TABASSUM, NAOMI (LPCC)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:TABASSUM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 23RD ST S
Mailing Address - Street 2:STE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-526-4898
Mailing Address - Fax:701-205-4734
Practice Address - Street 1:1330 23RD ST S
Practice Address - Street 2:STE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-526-4898
Practice Address - Fax:701-205-4734
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND771-2-1-14-268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health