Healthcare Provider Details

I. General information

NPI: 1114516234
Provider Name (Legal Business Name): AURORA MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 10/24/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 E. MAIN ST STE 1 #1328
NEW TOWN ND
58763-1328
US

IV. Provider business mailing address

PO BOX 1328
NEW TOWN ND
58763-1328
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-1545
  • Fax: 701-751-1635
Mailing address:
  • Phone: 701-751-1545
  • Fax: 701-751-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY MARIE HAM
Title or Position: COUNSELOR
Credential: MS, LPC/LPCC
Phone: 701-751-1545