Healthcare Provider Details

I. General information

NPI: 1841102696
Provider Name (Legal Business Name): GRACE TANIS LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S 9TH ST STE 108
BISMARCK ND
58504-5851
US

IV. Provider business mailing address

921 S 9TH ST STE 108
BISMARCK ND
58504-5851
US

V. Phone/Fax

Practice location:
  • Phone: 701-805-8102
  • Fax:
Mailing address:
  • Phone: 701-805-8102
  • Fax: 701-291-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1587-9-15-26A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: