Healthcare Provider Details

I. General information

NPI: 1437015864
Provider Name (Legal Business Name): CODI LYN TAHRAN LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 13TH ST NE
JAMESTOWN ND
58401-3586
US

IV. Provider business mailing address

804 13TH ST NE
JAMESTOWN ND
58401-3586
US

V. Phone/Fax

Practice location:
  • Phone: 701-952-5566
  • Fax: 701-952-5567
Mailing address:
  • Phone: 701-952-5566
  • Fax: 701-952-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1515-12-15-25A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: