Basic Information
| Provider Information | |||||||||
| NPI: | 1629319082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVENSTAD | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | NOEL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4733 AMBER VALLEY PKWY S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581048647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012778844 | ||||||||
| FaxNumber: | 7012778847 | ||||||||
| Practice Location | |||||||||
| Address1: | 4733 AMBER VALLEY PKWY S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581048647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012778844 | ||||||||
| FaxNumber: | 7012778847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2013 | ||||||||
| LastUpdateDate: | 03/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | L7 | ND | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.