| Nystrom & Associates Counseling Wi., S.c. | |
|
5354 42nd St S Fargo ND 58104-4032 | |
| (844) 697-8766 | |
| Not Available |
| Full Name | Nystrom & Associates Counseling Wi., S.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5354 42nd St S, Fargo, North Dakota |
| Authorized Official Name and Position | Mark James Peterson (CEO) |
| Authorized Official Contact | 6516289566 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nystrom & Associates Counseling Wi., S.c. 1900 Silver Lake Rd Nw New Brighton MN 55112-1786 Ph: (651) 379-1750 | Nystrom & Associates Counseling Wi., S.c. 5354 42nd St S Fargo ND 58104-4032 Ph: (844) 697-8766 |
| NPI Number | 1104549047 |
|---|---|
| Provider Enumeration Date | 09/26/2022 |
| Last Update Date | 10/24/2023 |
| Certification Date | 10/24/2023 |
| Medicare PECOS PAC ID | 1052729464 |
|---|---|
| Medicare Enrollment ID | O20230321002230 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104549047 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Pamela S Walls |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1962573394 PECOS PAC ID: 3476554338 Enrollment ID: I20160621000450 |
| Provider Name | Candis S Astolfi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760710784 PECOS PAC ID: 1456646538 Enrollment ID: I20160829001682 |
| Provider Name | Christine Michelle Hanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265042923 PECOS PAC ID: 0244659530 Enrollment ID: I20201006002710 |
| Provider Name | Courtney Kay Sedgwick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255647954 PECOS PAC ID: 3375777469 Enrollment ID: I20230516002275 |
| Provider Name | Erin Jeanette Tweed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609551696 PECOS PAC ID: 1355705047 Enrollment ID: I20230913004386 |
| Provider Name | Caylor Hunt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770175358 PECOS PAC ID: 7012367139 Enrollment ID: I20240102000966 |
| Provider Name | Rebecca E Pihl |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407343130 PECOS PAC ID: 4284084013 Enrollment ID: I20240102003464 |
| Provider Name | Erin Saladin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1407271638 PECOS PAC ID: 9335599539 Enrollment ID: I20240125004372 |
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