Provider Demographics
NPI:1750989174
Name:GRESS, MICHELLE (LPCC, LADC, LAC (ND))
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GRESS
Suffix:
Gender:F
Credentials:LPCC, LADC, LAC (ND)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 14TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2538
Mailing Address - Country:US
Mailing Address - Phone:507-456-6083
Mailing Address - Fax:
Practice Address - Street 1:2405 8TH ST S STE 200
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4200
Practice Address - Country:US
Practice Address - Phone:486-621-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1920101YA0400X
MN2367101YM0800X
MNCC03452101YM0800X
MN305623101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health