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Individual

LUKAS EISEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1531 32ND AVE S STE 102, FARGO, ND 58103-5911
Mailing address
1531 32ND AVE S STE 102, FARGO, ND 58103-5911
(701) 951-8512

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2022-084
ND
106H00000X
Marriage & Family Therapist
4155
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1386471167
ND
Enumeration date
09/06/2019
Last updated
12/16/2024
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