Provider Demographics
NPI:1154042018
Name:YOUTH BY BETHS PLACE LLC
Entity type:Organization
Organization Name:YOUTH BY BETHS PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LADC
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-936-1190
Mailing Address - Street 1:1606 30TH AVE S STE 2
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5147
Mailing Address - Country:US
Mailing Address - Phone:701-936-1190
Mailing Address - Fax:218-600-5488
Practice Address - Street 1:1606 30TH AVE S STE 2
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5147
Practice Address - Country:US
Practice Address - Phone:701-936-1190
Practice Address - Fax:218-600-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty