Basic Information
| Provider Information | |||||||||
| NPI: | 1619943776 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTWIND CONSULTING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 W VILLARD ST | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586015121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012251050 | ||||||||
| FaxNumber: | 7012256225 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 W VILLARD ST | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586015121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012251050 | ||||||||
| FaxNumber: | 7012256225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 07/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | FEHR | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7012251050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 665 | 01 | ND | BLUE CROSS BLUE SHIELD ND | OTHER | 012247 | 05 | ND | MEDICAID |