Provider Demographics
NPI:1033949128
Name:REALATIONAL THERAPY SERVICES
Entity type:Organization
Organization Name:REALATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:701-260-9713
Mailing Address - Street 1:3846 12TH ST W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8164
Mailing Address - Country:US
Mailing Address - Phone:701-260-9713
Mailing Address - Fax:
Practice Address - Street 1:102 W BEATON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2652
Practice Address - Country:US
Practice Address - Phone:701-347-1648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty