Healthcare Provider Details

I. General information

NPI: 1609283027
Provider Name (Legal Business Name): MICHAEL IKEN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 UNVIVERSITY DR
BISMARCK ND
58504
US

IV. Provider business mailing address

3315 UNVIVERSITY DR
BISMARCK ND
58504
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-3285
  • Fax: 701-530-0645
Mailing address:
  • Phone: 701-255-3285
  • Fax: 701-530-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number657-3-1-10
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: