Provider Demographics
NPI:1962831610
Name:SKUNBERG, MINDY L (LAPC)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:L
Last Name:SKUNBERG
Suffix:
Gender:
Credentials:LAPC
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6046 14TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7226
Mailing Address - Country:US
Mailing Address - Phone:701-404-0997
Mailing Address - Fax:701-566-8876
Practice Address - Street 1:300 2ND AVE NE STE 203
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-3373
Practice Address - Country:US
Practice Address - Phone:701-404-0997
Practice Address - Fax:701-566-8876
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1428-3-1-25A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional