Individual
FALLON KIRBY LEISETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 1ST AVE NW, WILLISTON, ND 58801
(701) 609-5376
Mailing address
12 1ST AVE W, WILLISTON, ND 58801-6048
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/01/2019
Last updated
11/12/2024
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