Healthcare Provider Details

I. General information

NPI: 1396632758
Provider Name (Legal Business Name): ALICIA MARY LEFTBEAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 183
TOKIO ND
58379-0183
US

IV. Provider business mailing address

PO BOX 183
TOKIO ND
58379-0183
US

V. Phone/Fax

Practice location:
  • Phone: 701-350-1282
  • Fax:
Mailing address:
  • Phone: 701-350-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: