Organization
INNER LIGHT COUNSELING SERVICES, LTD
Active
Other names
Inner Light Counseling Services
Organization subpart
No
Provider details
NPI number
Authorized official
MYSTAL AXTMAN LPCC (OWNER)
(701) 478-0906
Entity
Organization
Contact information
Practice address
4675 40TH AVE S STE 115, FARGO, ND 58104-4592
(701) 478-0906
(701) 478-0909
Mailing address
4675 40TH AVE S STE 115, FARGO, ND 58104-4592
(701) 478-0906
(701) 478-0909
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
04/19/2021
Last updated
02/15/2023
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