Healthcare Provider Details

I. General information

NPI: 1053480855
Provider Name (Legal Business Name): JAMES LEIN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 4TH AVE NW
MINOT ND
58703-2912
US

IV. Provider business mailing address

1705 4TH AVE NW
MINOT ND
58703-2912
US

V. Phone/Fax

Practice location:
  • Phone: 701-839-0474
  • Fax: 701-839-0713
Mailing address:
  • Phone: 701-839-0474
  • Fax: 701-839-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number582
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier26591
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier19164
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: