Individual
BRYAN ALLEN BLOEMENDAAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAC
Contact information
Practice address
4215 9TH AVE S, FARGO, ND 58103-2018
(701) 373-8667
Mailing address
5050 40TH AVE S, APT 203, FARGO, ND 58104-8906
(507) 215-2096
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1797
ND
101YA0400X
Addiction (Substance Use Disorder) Counselor
304586
MN
Other
Enumeration date
08/09/2016
Last updated
08/29/2016
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