Active NPI
Larry Jerome Watnemo, LPCC
- Professional Counselor
- Fargo, ND
National Provider Identifier
1063568301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- ND 392-12-1-97-83
- Practice address
- 1112 Nodak Dr S
Fargo, ND 58103-2366 - Phone
- (701) 232-6224
- Fax
- (701) 232-4687
- NPI assigned
- Jan 27, 2007
- Last updated
- May 20, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | ND 392-12-1-97-83 | ND | Primary |
Addresses
Primary practice location
1112 Nodak Dr S
Fargo, ND 58103-2366
Mailing address
1112 Nodak Dr S
Fargo, ND 58103-2366
Phone (701) 232-6224
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1468231 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589932800000",
"number": "1063568301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1112 NODAK DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581032366",
"telephone_number": "701-232-6224",
"fax_number": "701-232-4687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1112 NODAK DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581032366",
"telephone_number": "701-232-6224",
"fax_number": "701-232-4687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATNEMO",
"first_name": "LARRY",
"middle_name": "JEROME",
"name_prefix": "Dr.",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-27",
"last_updated": "2020-05-20",
"certification_date": "2020-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ND",
"license": "ND 392-12-1-97-83",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1468231",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.