Provider Demographics
NPI:1285968404
Name:EYLANDS, MARY REITEN (LPCC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:REITEN
Last Name:EYLANDS
Suffix:
Gender:F
Credentials:LPCC
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Mailing Address - Street 1:600 DEMERS AVE
Mailing Address - Street 2:US BANK BUILDING - SUITE 404
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4599
Mailing Address - Country:US
Mailing Address - Phone:701-746-4400
Mailing Address - Fax:701-746-6034
Practice Address - Street 1:600 DEMERS AVE
Practice Address - Street 2:US BANK BUILDING - SUITE 404
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4599
Practice Address - Country:US
Practice Address - Phone:701-746-4400
Practice Address - Fax:701-746-6034
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND505-3-15-04-166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional