Provider Demographics
NPI:1528115052
Name:HJELLE, CATHERINE AGNES (LPCC LICSW)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:AGNES
Last Name:HJELLE
Suffix:
Gender:F
Credentials:LPCC LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 45TH ST S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8970
Mailing Address - Country:US
Mailing Address - Phone:701-356-4384
Mailing Address - Fax:701-356-4383
Practice Address - Street 1:3401 45TH ST S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8970
Practice Address - Country:US
Practice Address - Phone:701-356-4384
Practice Address - Fax:701-356-4383
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN06714101YM0800X
ND3881219779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN082217500Medicaid
07N62HJOtherBLUE CROSS OF MN
27082OtherBLUE CROSS OF ND
6258618OtherUNITED BEHAVIORAL HEALTH