Provider Demographics
NPI:1811437916
Name:CLARITY COUNSELING, PLLC
Entity type:Organization
Organization Name:CLARITY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TALLAKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:701-364-4040
Mailing Address - Street 1:808 3RD AVE S
Mailing Address - Street 2:STE 303
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:808 3RD AVE S
Practice Address - Street 2:STE 303
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1865
Practice Address - Country:US
Practice Address - Phone:701-364-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4765102175251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598848897OtherNPI I