Provider Demographics
NPI:1306579206
Name:GRAND FORKS COUNSELING AND THERAPY PLLC
Entity type:Organization
Organization Name:GRAND FORKS COUNSELING AND THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHANDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-610-1242
Mailing Address - Street 1:1407 24TH AVE S STE 206
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6773
Mailing Address - Country:US
Mailing Address - Phone:701-610-1242
Mailing Address - Fax:
Practice Address - Street 1:1407 24TH AVE S STE 206
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6773
Practice Address - Country:US
Practice Address - Phone:701-610-1242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty