Kevin Ross Juntunen, LAC

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Raleigh, ND

NPI 1104058254 · NPPES record last updated Apr 15, 2025

Key facts

NPI
1104058254
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
1607 (ND)
Practice address
7785 Saint Gertrude Ave
Raleigh, ND 58564-4103
Phone
(701) 597-3419
NPI assigned
Aug 21, 2009
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1607NDMDAddiction (Substance Use Disorder) Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1607 ND Yes

Addresses

Primary practice location

7785 Saint Gertrude Ave
Raleigh, ND 58564-4103

Mailing address

614 9TH Ave NE
Rolla, ND 58367-7303
Phone (701) 278-1192

Other providers in Raleigh, ND

All providers in Raleigh, ND · Addiction (Substance Use Disorder) Counselor in North Dakota

Sources for this page

Verify at the official NPI Registry.