Individual
KEITH ALLEN GILLESHAMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED, LAC
Contact information
Practice address
409 7TH ST S, FARGO, ND 58103-1821
(701) 293-3384
(701) 293-3759
Mailing address
409 7TH ST S, FARGO, ND 58103-1821
(701) 293-3384
(701) 293-3759
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
26814
ND
Other
Enumeration date
02/16/2011
Last updated
02/17/2020
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