Provider Demographics
NPI:1144094459
Name:PEAK PATHWAYS PC
Entity type:Organization
Organization Name:PEAK PATHWAYS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:701-941-0175
Mailing Address - Street 1:4160 24TH AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-9038
Mailing Address - Country:US
Mailing Address - Phone:701-941-0175
Mailing Address - Fax:701-941-3001
Practice Address - Street 1:3523 45TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8962
Practice Address - Country:US
Practice Address - Phone:701-941-0175
Practice Address - Fax:701-941-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND113561521545OtherSTATE LICENSE