Healthcare Provider Details

I. General information

NPI: 1295367449
Provider Name (Legal Business Name): WINDS OF CHANGE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 7TH ST. W, DOOR A
DICKINSON ND
58601
US

IV. Provider business mailing address

PO BOX 810
DICKINSON ND
58602-0810
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-0230
  • Fax: 701-483-0231
Mailing address:
  • Phone: 701-483-0230
  • Fax: 701-483-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELLY M HALL
Title or Position: CLINICAL PSYCHOLOGICAL
Credential: PSYD
Phone: 701-483-0230