Organization
AGASSIZ ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA M. GREEN PH.D. (CO-OWNER)
(701) 746-6336
Entity
Organization
Contact information
Practice address
2424 32ND AVE S, STE 202, GRAND FORKS, ND 58201-6545
(701) 746-6336
(701) 772-1030
Mailing address
2424 32ND AVE S, STE 202, GRAND FORKS, ND 58201-6545
(701) 746-6336
(701) 772-1030
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457916
—
ND
01
—
309K4AG
BLUECROSSBLUESHIELD OF MN
MN
Enumeration date
10/04/2006
Last updated
01/23/2017
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