MEDICARE: DAKOTA FAMILY SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06641001	OTHER	ND	BLUE CROSS BLUE SHIELD ND
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639130917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAKOTA FAMILY SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 1148
Second Line	:
City	:	MINOT
State	:	ND
Zip	:	58702-1148
Country	:	US
Telephone Number	:	701-858-0115
Fax Number	:	701-852-1190

Provider Business Practice Location Address
First Line	:	600 22ND AVE NW
Second Line	:
City	:	MINOT
State	:	ND
Zip	:	58703-0986
Country	:	US
Telephone Number	:	701-837-6508
Fax Number	:	701-858-1839

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SHONDELL L GANTZER
Credential	:
Telephone Number	:	701-858-0115

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	07/20/2009

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Directions to “DAKOTA FAMILY SERVICES, INC ” Practice Location

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