Healthcare Provider Details

I. General information

NPI: 1982419149
Provider Name (Legal Business Name): TAYLOR NOELLE REESE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 7TH ST W APT 116
WILLISTON ND
58801-4273
US

IV. Provider business mailing address

3705 7TH ST W APT 116
WILLISTON ND
58801-4273
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-4600
  • Fax:
Mailing address:
  • Phone: 701-421-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-APP-77668
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2035
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: