Healthcare Provider Details

I. General information

NPI: 1942881560
Provider Name (Legal Business Name): MILESTONE HEALTH PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MAIN ST
WILLISTON ND
58801-6020
US

IV. Provider business mailing address

205 MAIN ST
WILLISTON ND
58801-6020
US

V. Phone/Fax

Practice location:
  • Phone: 701-651-6437
  • Fax: 701-516-8462
Mailing address:
  • Phone: 701-770-2734
  • Fax: 701-516-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALYSSA SUESS
Title or Position: AUTHORIZED OFFICIAL
Credential: PHD
Phone: 701-770-2734