Provider Demographics
NPI:1801999461
Name:ALTENDORF, JOHN GERARD (MED LPCC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GERARD
Last Name:ALTENDORF
Suffix:
Gender:M
Credentials:MED LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 PAGE DR S STE 100
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3536
Mailing Address - Country:US
Mailing Address - Phone:701-412-7345
Mailing Address - Fax:701-478-4044
Practice Address - Street 1:1351 PAGE DR S STE 100
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3536
Practice Address - Country:US
Practice Address - Phone:701-412-7345
Practice Address - Fax:701-478-4044
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND347319655101YP1600X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral