Healthcare Provider Details

I. General information

NPI: 1578386363
Provider Name (Legal Business Name): LEVI GRESETH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 3RD ST NW
JAMESTOWN ND
58401-2968
US

IV. Provider business mailing address

1012 10TH ST NE APT 17
JAMESTOWN ND
58401-6520
US

V. Phone/Fax

Practice location:
  • Phone: 701-253-6404
  • Fax: 701-253-6400
Mailing address:
  • Phone: 605-268-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2000
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: