Provider Demographics
NPI:1104227925
Name:IRISH-ZABOLOTNY, ALLEN JAMES (LPC, LPCC)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:JAMES
Last Name:IRISH-ZABOLOTNY
Suffix:
Gender:M
Credentials:LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 AMBER VALLEY PKWY S STE W
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-9073
Mailing Address - Country:US
Mailing Address - Phone:701-401-6117
Mailing Address - Fax:701-540-0059
Practice Address - Street 1:4733 AMBER VALLEY PKWY S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8647
Practice Address - Country:US
Practice Address - Phone:701-220-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND863-1-15-16101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health