Provider Demographics
NPI:1548339971
Name:HANDTE, VANESSA R (LAC, LPC)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:R
Last Name:HANDTE
Suffix:
Gender:F
Credentials:LAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 40TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-364-2331
Mailing Address - Fax:
Practice Address - Street 1:2624 9TH AVE SW
Practice Address - Street 2:SOUTHEAST HUMAN SERVICE CENTER
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2350
Practice Address - Country:US
Practice Address - Phone:701-298-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1383101YA0400X
ND578-2-15-07101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
25640OtherBCBS
412781043738OtherPREFERRED ONE