Healthcare Provider Details

I. General information

NPI: 1114119989
Provider Name (Legal Business Name): DAKOTA FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 19TH AVE NW
MINOT ND
58703-8899
US

IV. Provider business mailing address

PO BOX 5007
MINOT ND
58702-5007
US

V. Phone/Fax

Practice location:
  • Phone: 701-837-6508
  • Fax: 701-837-9953
Mailing address:
  • Phone: 701-837-6508
  • Fax: 701-837-9953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMMY MORENO
Title or Position: CREDENTIALING
Credential:
Phone: 701-364-2950