Healthcare Provider Details

I. General information

NPI: 1679654305
Provider Name (Legal Business Name): TAMI S JOLLIE-TROTTIER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 HOSPITAL RD SUITE A
BELCOURT ND
58316-0160
US

IV. Provider business mailing address

PO BOX 1149 SUITE A PO BOX 1149
BELCOURT ND
58316-0160
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-0428
  • Fax: 701-477-0488
Mailing address:
  • Phone: 701-477-0428
  • Fax: 701-477-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number411
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: