Experience Counseling Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1633 Issued in ND

Legal business name

EXPERIENCE COUNSELING SERVICES

Practice address

3523 45TH St S
Fargo, ND 58104-8962

Phone

(701) 639-6561

NPI assigned

Jan 30, 2017

Last updated

Jan 30, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amanda Rae Decker, LAC

Title

Ceo

Phone

(701) 639-6561

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1194262014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3523 45TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048962",
            "telephone_number": "701-639-6561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3523 45TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048962",
            "telephone_number": "701-639-6561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPERIENCE COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-30",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "DECKER",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-639-6561",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "ND",
            "license": "1633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.