Healthcare Provider Details

I. General information

NPI: 1023553088
Provider Name (Legal Business Name): MS. JULAINE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULI SMITH LPC

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 KUNDERT ST
TURTLE LAKE ND
58575-4205
US

IV. Provider business mailing address

104 MAIN ST
TURTLE LAKE ND
58575-4001
US

V. Phone/Fax

Practice location:
  • Phone: 701-448-9225
  • Fax:
Mailing address:
  • Phone: 701-448-2054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number122781522513
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1383
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: