Provider Demographics
NPI:1831981760
Name:GREEN PRAIRIE COUNSELING PLLC
Entity type:Organization
Organization Name:GREEN PRAIRIE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIDAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:AVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-205-2469
Mailing Address - Street 1:2057 12TH ST W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-4845
Mailing Address - Country:US
Mailing Address - Phone:701-205-2469
Mailing Address - Fax:
Practice Address - Street 1:22 6TH ST N
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-422-6032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty