Healthcare Provider Details

I. General information

NPI: 1720054810
Provider Name (Legal Business Name): DICKINSON FAMILY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 2ND AVE E SUITE B
DICKINSON ND
58601-5218
US

IV. Provider business mailing address

11 2ND AVE E SUITE B
DICKINSON ND
58601-5218
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-9720
  • Fax: 701-483-9721
Mailing address:
  • Phone: 701-483-9720
  • Fax: 701-483-9721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN M BAER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 701-483-9720