Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1861989824 |
---|---|
Provider Name | Valerie Foran |
First Address | Fargo, ND 58104-4247 |
Second Address | Fargo, ND 58103-4940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2018 |
Last Update Date | 16/04/2018 |