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Wallace Larry Klostreich, LAC
Addiction (Substance Use Disorder) Counselor in Bismarck, North Dakota
NPI 1073540415

Wallace Larry Klostreich is an Addiction (Substance Use Disorder) Counselor based in Bismarck, ND and is specialized in Addiction (Substance Use Disorder). Wallace Larry Klostreich practices in Bismarck, ND and has the professional credentials of LAC. The NPI Number for Wallace Larry Klostreich is 1073540415 and holds a License No. 1073 (North Dakota).

The current practice location address for Wallace Larry Klostreich is 1237 W Divide Ave, Bismarck, ND and can be reached out via phone at 701-328-8892 and via fax at 701-328-8900.

Location: 1237 W Divide Ave, Bismarck, ND, 58501-1208
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Provider Profile Details
NPI Number
1073540415
Provider Name
Wallace Larry Klostreich
Credential
LAC
Provider Entity Type
Individual
Gender
Male
Address
1237 W Divide Ave, Bismarck, ND, 58501-1208
Phone Number
701-328-8892
Fax Number
701-328-8900
Provider Enumeration Date
06/28/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
024576 01 BCBS OF ND
institution
Provider Business Practice Location Address Details
Address
1237 W Divide Ave
City
State
Zip
58501-1208
Phone Number
701-328-8892
Fax Number
701-328-8900
person
Provider Business Mailing Address Details
Address
1237 W Divide Ave
City
State
Zip
58501-1208
Phone Number
701-328-8892
Fax Number
701-328-8900
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
1073 (North Dakota)
Definition
Definition to come...
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