Healthcare Provider Details

I. General information

NPI: 1306042098
Provider Name (Legal Business Name): MOUNTAIN-PLAINS YOUTH SERVICES COALITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W ROSSER AVE
BISMARCK ND
58501-3755
US

IV. Provider business mailing address

217 W ROSSER AVE
BISMARCK ND
58501-3755
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-6909
  • Fax: 701-255-3922
Mailing address:
  • Phone: 701-255-6909
  • Fax: 701-255-3922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MELANIE A HEITKAMP
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 701-255-6909