Provider Demographics
NPI:1982117602
Name:NEXUS-PATH FAMILY HEALING
Entity Type:Organization
Organization Name:NEXUS-PATH FAMILY HEALING
Other - Org Name:PATH TRAUMA AND STRESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN RESOURCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUKOL
Authorized Official - Suffix:
Authorized Official - Credentials:PHR
Authorized Official - Phone:701-551-6318
Mailing Address - Street 1:1202 WESTRAC DR S STE 400
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2356
Mailing Address - Country:US
Mailing Address - Phone:701-280-9545
Mailing Address - Fax:701-280-0038
Practice Address - Street 1:1202 WESTRAC DR S STE 400
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2356
Practice Address - Country:US
Practice Address - Phone:701-280-9545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXUS-PATH FAMILY HEALING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-16
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1459676Medicaid
ND1472885Medicaid