Healthcare Provider Details

I. General information

NPI: 1972231801
Provider Name (Legal Business Name): COURTNEY LEBEN-PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY LEBEN

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 COLEMAN ST STE 203
BISMARCK ND
58503-2017
US

IV. Provider business mailing address

1547 30TH AVE S
MOORHEAD MN
56560-5149
US

V. Phone/Fax

Practice location:
  • Phone: 701-412-2973
  • Fax: 701-237-4407
Mailing address:
  • Phone: 218-287-4338
  • Fax: 218-287-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6096
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberBMS00089
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: