Jamie Anderson, LAPC
Individual provider Active NPI Professional Counselor · Fargo, ND
NPI 1073883773 · NPPES record last updated Apr 19, 2018
Key facts
- NPI
- 1073883773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 706-12-15-11A (ND)
- Practice address
- 3401 45TH St S Ste a
Fargo, ND 58104-8970 - Phone
- (013) 564-3847
- NPI assigned
- Jan 11, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250225001654 | ND | Practitioner - Mental Health Counselor | 4688194343 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Therapy Partners, Inc. | Professional | Current |
Accepting new patients |
Locations
3401 45th St S
#A
Fargo, ND 58104
Phone (701) 356-4384
3060 Frontier Way S
Fargo, ND 58104
Phone (701) 356-4384
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 706-12-15-11A | ND | Yes |
Addresses
Primary practice location
3401 45TH St S Ste a
Fargo, ND 58104-8970
Mailing address
3401 45TH St S Ste a
Fargo, ND 58104-8970
Phone (701) 356-4384
Other practice location 1
1201 25th St S
Fargo, ND 58103-2311
Phone (701) 451-4900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1462276 | Medicaid | ND |
Other providers in Fargo, ND
- Donal M Anderson
- Edith Anderson
- Elizabeth Anderson
- Elizabeth Renae Anderson
- Jadean Jake Anderson
- Jennifer Lenore Anderson
- Joan M Anderson
- Joelle Denise Anderson
- Jon D Anderson
- Justin Earl Anderson
All providers in Fargo, ND · Professional Counselor in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.