| Doctor Name: | DHARMA RAJ PANTHA |
| NPI Number: | 1285930735 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LAC, LPC |
| License Number: | 678-1-1-11 |
| Business Practice Address: | 1820 Walnut St E Suit # 7 Devils Lake, ND - 583013411 |
| Business Phone Number: | 7016652149 |
| Business Fax Number: | 7016652153 |
| Mailing Address: | 231 Kemp Ave Se, Apt # 112 DEVILS LAKE |
| State: | ND |
| Postal Code: | 583013978 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/01/2011 |
| NPI Last Update Date: | 02/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 678-1-1-11 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ND |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |