Healthcare Provider Details

I. General information

NPI: 1003009457
Provider Name (Legal Business Name): VOLK HUMAN SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 3RD ST NE STE 1
DEVILS LAKE ND
58301-3006
US

IV. Provider business mailing address

501 3RD ST NE STE 1
DEVILS LAKE ND
58301-3006
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-1911
  • Fax:
Mailing address:
  • Phone: 701-662-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number269
License Number StateND

VIII. Authorized Official

Name: TARA RHAE AVDEM
Title or Position: BUSINESS MANAGER
Credential:
Phone: 701-662-1911