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Individual

MYSTAL RAE AXTMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S., LPCC

Contact information

Practice address
4675 40TH AVE S STE 115, FARGO, ND 58104-4592
(701) 478-0906
Mailing address
4675 40TH AVE S STE 115, FARGO, ND 58104-4592
(701) 541-1547

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
472-3-1-02-164
ND
101YP2500X
Professional Counselor
Primary
472-3-1-02-164
ND

Other

Enumeration date
02/09/2007
Last updated
02/15/2023
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