Provider Demographics
NPI:1962130666
Name:CHOICE RECOVERY COUNSELING, PLLC
Entity type:Organization
Organization Name:CHOICE RECOVERY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED ADDICTION C
Authorized Official - Phone:701-770-9743
Mailing Address - Street 1:705 E HIGHLAND DR STE E
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4494
Mailing Address - Country:US
Mailing Address - Phone:701-770-9743
Mailing Address - Fax:701-572-5410
Practice Address - Street 1:705 E HIGHLAND DR STE E
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4494
Practice Address - Country:US
Practice Address - Phone:701-770-9743
Practice Address - Fax:701-572-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND101YA0400XMedicaid