Provider Demographics
NPI:1972350312
Name:NORTHERN THERAPY AND CONSULTING, LLC
Entity type:Organization
Organization Name:NORTHERN THERAPY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:A BUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:218-368-7448
Mailing Address - Street 1:522 BELTRAMI AVE NW STE 105
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3002
Mailing Address - Country:US
Mailing Address - Phone:218-368-7448
Mailing Address - Fax:
Practice Address - Street 1:522 BELTRAMI AVE NW STE 105
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3002
Practice Address - Country:US
Practice Address - Phone:218-368-7448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN THERAPY AND CONSULTING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty