Individual
MR. SHANNON PAUL WEISZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD, LAC
Contact information
Practice address
309 N MANDAN ST, SUITE #1, BISMARCK, ND 58501-3886
(701) 323-0924
(701) 323-0935
Mailing address
309 N MANDAN ST, SUITE #1, BISMARCK, ND 58501-3886
(701) 323-0924
(701) 323-0935
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1549
ND
103T00000X
Psychologist
Primary
470
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17326
—
ND
Enumeration date
11/21/2006
Last updated
07/22/2014
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