Stephanie Anne Abbott, LAPC
Individual provider Active NPI Professional Counselor · Fargo, ND
NPI 1578048625 · NPPES record last updated Aug 26, 2020
Key facts
- NPI
- 1578048625
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 1042-11-15-19A (ND)
- Practice address
- 2624 9TH Ave S
Fargo, ND 58103-2350 - Phone
- (701) 298-4500
- Fax
- (701) 298-4400
- NPI assigned
- Sep 25, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|---|
| I20240302000254 | ND | Practitioner - Mental Health Counselor | 6204271075 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Behavioral Health Clinic | Current |
Accepting new patients |
Locations
600 E Boulevard Ave
Dept 325
Bismarck, ND 58505
Phone (701) 328-4644
2624 9th Ave SW
Fargo, ND 58103
Phone (701) 298-4500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Professional Counselor | 101YP2500X | 1042-11-15-19A | ND | Yes |
Addresses
Primary practice location
2624 9TH Ave S
Fargo, ND 58103-2350
Mailing address
2624 9TH Ave S
Fargo, ND 58103-2350
Phone (701) 298-4500
Other names
- Stephanie Anne Brest
Other providers in Fargo, ND
- Payton Aasved
- Deborah Kay Abbey
- Alexis J Abbott
- David W. Abbott
- Sarah Abbott
- Abc Chiropractic PC
- Farah Abdalla
- Fatima Abdalla
- Ilham Abdalla
- Kaltun Abdi
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 Aug 26, 2020. 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.