Healthcare Provider Details

I. General information

NPI: 1922626456
Provider Name (Legal Business Name): TESS R JOHNSON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 1ST AVE W STE 160
DICKINSON ND
58601-5157
US

IV. Provider business mailing address

579 RIVER DRIVE
DICKINSON ND
58601
US

V. Phone/Fax

Practice location:
  • Phone: 701-787-1100
  • Fax: 701-787-1600
Mailing address:
  • Phone: 701-521-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TESS R JOHNSON
Title or Position: OWNER OF PRIVATE PRACTICE/THERAPIST
Credential: LPCC
Phone: 701-521-0503