Healthcare Provider Details

I. General information

NPI: 1144146176
Provider Name (Legal Business Name): TIA MARIE DOLECHEK LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 S WASHINGTON ST STE 204
BISMARCK ND
58504-6284
US

IV. Provider business mailing address

3410 TEXAS LOOP
BISMARCK ND
58503-1577
US

V. Phone/Fax

Practice location:
  • Phone: 701-670-4200
  • Fax:
Mailing address:
  • Phone: 701-670-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1561-6-15-26A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: