Healthcare Provider Details

I. General information

NPI: 1477475606
Provider Name (Legal Business Name): AUDREY LYNN TRI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SCHLOSSER AVE
MANDAN ND
58554-5213
US

IV. Provider business mailing address

116 SCHLOSSER AVE
MANDAN ND
58554-5213
US

V. Phone/Fax

Practice location:
  • Phone: 406-407-5605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6720
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: