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ONLY HUMAN COUNSELING SERVICES, LLP
Complete NPI Record 1750597639
Social Worker - Clinical in Fargo, ND

NPI Status: Active since May 15, 2007

Contact Information

118 BROADWAY N STE 517
FARGO, ND
ZIP 58102
Phone: (701) 476-0497
Fax: (701) 298-7811

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Middle Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Provider License Number 1
  28. Provider License Number State Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Healthcare Provider Taxonomy Code 2
  31. Provider License Number 2
  32. Provider License Number State Code 2
  33. Healthcare Provider Primary Taxonomy Switch 2
  34. Healthcare Provider Taxonomy Code 3
  35. Provider License Number 3
  36. Provider License Number State Code 3
  37. Healthcare Provider Primary Taxonomy Switch 3
  38. Healthcare Provider Taxonomy Code 4
  39. Provider License Number 4
  40. Provider License Number State Code 4
  41. Healthcare Provider Primary Taxonomy Switch 4
  42. Other Provider Identifier 1
  43. Other Provider Identifier Type Code 1
  44. Other Provider Identifier State 1
  45. Other Provider Identifier Issuer 1
  46. Other Provider Identifier 2
  47. Other Provider Identifier Type Code 2
  48. Other Provider Identifier State 2
  49. Other Provider Identifier Issuer 2
  50. Other Provider Identifier 3
  51. Other Provider Identifier Type Code 3
  52. Other Provider Identifier State 3
  53. Other Provider Identifier Issuer 3
  54. Other Provider Identifier 4
  55. Other Provider Identifier Type Code 4
  56. Other Provider Identifier State 4
  57. Other Provider Identifier Issuer 4
  58. Is Organization Subpart
  59. Authorized Official Name Prefix Text
  60. Authorized Official Credential Text
  61. Healthcare Provider Taxonomy Group 1
  62. Healthcare Provider Taxonomy Group 2
  63. Healthcare Provider Taxonomy Group 3
  64. Healthcare Provider Taxonomy Group 4

Complete NPI Dataset

This page represents the complete record for NPI 1750597639. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1750597639
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Entity Type Code: 2
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Employer Identification Number EIN: UNAVAIL
The city name in the mailing address of the provider being identified.
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider First Line Business Mailing Address: 118 BROADWAY N STE 517
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address City Name: FARGO
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address State Name: ND
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Postal Code: 581024946
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7014760497
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 7012987811
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 118 BROADWAY N STE 517
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: FARGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: ND
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Business Practice Location Address Postal Code: 581024946
The last name of the provider. If the provider is an individual, this is the legal name.
Provider Business Practice Location Address Country Code If outside U S : US
The first name of the provider, if the provider is an individual.
Provider Business Practice Location Address Telephone Number: 7014760497
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Business Practice Location Address Fax Number: 7012987811
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Enumeration Date: 5/15/2007
The city name in the mailing address of the provider being identified.
Last Update Date: 8/27/2007
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Authorized Official Last Name: DUCKWITZ
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Authorized Official First Name: LINDA
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Authorized Official Middle Name: F
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Authorized Official Title or Position: CO-OWNER
The title or position of the authorized official.
Authorized Official Telephone Number: 7014760497
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 101YA0400X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 1024
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: ND
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 101YA0400X
Provider License Number 2: 1058
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: ND
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 104100000X
Provider License Number 3: 856
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: ND
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 1041C0700X
Provider License Number 4: 814
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: ND
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: Y
Other Provider Identifier 1: 27627
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: ND
Other Provider Identifier Issuer 1: DUCKWITZ BCBS LICSW
Other Provider Identifier 2: 27627
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: ND
Other Provider Identifier Issuer 2: DUCKWITZ BCBS LAC PROVIDE
Other Provider Identifier 3: 1176
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: ND
Other Provider Identifier Issuer 3: LICENSE ADDICTION FACILIT
Other Provider Identifier 4: 000014
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: ND
Other Provider Identifier Issuer 4: ISAPS
Is Organization Subpart: N
Authorized Official Name Prefix Text: MS.
Authorized Official Credential Text: LICSW, LAC
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP