Healthcare Provider Details

I. General information

NPI: 1639716806
Provider Name (Legal Business Name): ROBERTSON COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 01/31/2023
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BURDICK EXPY E STE 101
MINOT ND
58701-5006
US

IV. Provider business mailing address

2400 BURDICK EXPY E STE 101
MINOT ND
58701-5006
US

V. Phone/Fax

Practice location:
  • Phone: 701-335-6005
  • Fax: 701-837-9244
Mailing address:
  • Phone: 701-335-6005
  • Fax: 701-837-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN ROBERTSON
Title or Position: CO-OWNER
Credential: LCSW
Phone: 701-335-6005