Healthcare Provider Details

I. General information

NPI: 1841874401
Provider Name (Legal Business Name): PRAIRIE POINT COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 43RD AVE NE
BISMARCK ND
58503-6140
US

IV. Provider business mailing address

205 4TH AVE NW
MANDAN ND
58554-3135
US

V. Phone/Fax

Practice location:
  • Phone: 701-502-6704
  • Fax:
Mailing address:
  • Phone: 701-391-7661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LYNSEY DIEHL
Title or Position: MENTAL HEALTH COUNSELOR
Credential: MS LPCC
Phone: 701-391-7661