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MS. MELODY R PETERSON LAC

Addiction Substance Use Disorder

Fargo, North Dakota

Provider NPI: 1255348504

Provider Information:
MS. MELODY R PETERSON LAC
Gender: F
Not Sole Proprietor

Practice Location:
2624 9TH AVE S  FARGO, ND 58103 US
Tel: 701-298-4500  Fax: 701-298-4400

Business Mailing Address:
2624 9TH AVE S  FARGO, ND 58103 US
Tel: 701-298-4500  Fax: 701-298-4400

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
ND1269
X171M00000XOther Service Providers
Case Manager/Care Coordinator
ND

Other Provider Identifiers:

IssuerNumberStateType
BSBS OF ND PIN009179NC01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS ND - Page 1



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