Provider Demographics
NPI:1205095361
Name:ANDERSEN, MARY JO ELIZABETH (NCC, LPCC)
Entity type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:ELIZABETH
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:NCC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5201 BISHOPS BLVD S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7608
Mailing Address - Country:US
Mailing Address - Phone:701-235-4457
Mailing Address - Fax:701-356-7993
Practice Address - Street 1:5201 BISHOPS BLVD S
Practice Address - Street 2:SUITE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7608
Practice Address - Country:US
Practice Address - Phone:701-235-4457
Practice Address - Fax:701-356-7993
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND51710104176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional