Provider Demographics
NPI:1609054154
Name:DRAKE COUNSELING SERVICES
Entity type:Organization
Organization Name:DRAKE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAREBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-293-5429
Mailing Address - Street 1:1202 23 ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-293-5429
Mailing Address - Fax:701-293-0736
Practice Address - Street 1:919 8 AVE N
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56561
Practice Address - Country:US
Practice Address - Phone:701-293-5429
Practice Address - Fax:701-293-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3002Medicaid
ND3002Medicaid