Healthcare Provider Details

I. General information

NPI: 1700732773
Provider Name (Legal Business Name): TALIA ERIN DANAE BICKERT LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4719 SHELBURNE ST STE 9
BISMARCK ND
58503-5677
US

IV. Provider business mailing address

4720 N 19TH ST APT 205
BISMARCK ND
58503-5481
US

V. Phone/Fax

Practice location:
  • Phone: 701-299-3353
  • Fax: 701-299-4519
Mailing address:
  • Phone: 253-514-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1540-5-1-26A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: