Healthcare Provider Details

I. General information

NPI: 1497416507
Provider Name (Legal Business Name): TRICHELE SMITH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 4TH AVE NW
MINOT ND
58703-2912
US

IV. Provider business mailing address

10890 45TH AVE NW # 156
SHERWOOD ND
58782-9701
US

V. Phone/Fax

Practice location:
  • Phone: 701-839-0474
  • Fax: 701-839-0713
Mailing address:
  • Phone: 701-833-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6186
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6186
License Number StateND

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: