Local City Search for Psychiatrists, Psychologists, Therapists, Counselors and Mental Health Treatment CentersWALLACE LARRY KLOSTREICH LAC
Addiction Substance Use Disorder
Bismarck, North Dakota
Provider NPI: 1073540415
Provider Information:WALLACE LARRY KLOSTREICH LAC
Gender: M
Not Sole Proprietor
Practice Location:
1237 W DIVIDE AVE STE 5 BISMARCK, ND 58501 US
Tel: 701-328-8892 Fax: 701-328-8900
Business Mailing Address:
1237 W DIVIDE AVE STE 5 BISMARCK, ND 58501 US
Tel: 701-328-8892 Fax: 701-328-8900
Entity Type: Individual
Taxonomy:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101YA0400X | Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder) | ND | 1073 |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| BCBS OF ND | 024576 | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
