Healthcare Provider Details

I. General information

NPI: 1316541790
Provider Name (Legal Business Name): DAKOTA TRAUMA THERAPY AND NEUROPSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N 14TH ST STE 3A
BISMARCK ND
58503-0697
US

IV. Provider business mailing address

311 N MANDAN ST # 1
BISMARCK ND
58501-3859
US

V. Phone/Fax

Practice location:
  • Phone: 701-581-6625
  • Fax:
Mailing address:
  • Phone: 701-415-6745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DAVID BROOKS
Title or Position: OWNER
Credential:
Phone: 701-415-6745