Healthcare Provider Details

I. General information

NPI: 1811822018
Provider Name (Legal Business Name): DANA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAYNA MARTIN

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MAIN ST STE 205
WILLISTON ND
58801-6030
US

IV. Provider business mailing address

125 MAIN ST STE 205
WILLISTON ND
58801-6030
US

V. Phone/Fax

Practice location:
  • Phone: 701-380-5100
  • Fax:
Mailing address:
  • Phone: 701-380-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1557-6-15-26A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: