Healthcare Provider Details

I. General information

NPI: 1316860554
Provider Name (Legal Business Name): BRIANNA FLECK LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 6TH AVE SW
BOWMAN ND
58623-4506
US

IV. Provider business mailing address

201 7TH AVE SW
BOWMAN ND
58623-4514
US

V. Phone/Fax

Practice location:
  • Phone: 701-523-7694
  • Fax: 701-523-7695
Mailing address:
  • Phone: 701-440-1322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2417
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: